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Exam (elaborations)

CDEO Chapter 3 Exam Questions With Revised Answers

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CDEO Chapter 3 Exam Questions With Revised Answers Documentation states that the patient had a "Status post hysterectomy. The patient presents with a fever." Which of the following would be a compliant question to query? - answerDo you know the cause of the fever? Operation Restore Trust - ans...

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  • September 4, 2024
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  • 2024/2025
  • Exam (elaborations)
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CDEO Chapter 3 Exam Questions With
Revised Answers


Documentation states that the patient had a "Status post hysterectomy. The patient presents with
a fever." Which of the following would be a compliant question to query? - answer✔✔Do you
know the cause of the fever?

Operation Restore Trust - answer✔✔3 offices were involved: OIG, Healthcare Financing
Administration, AoA


May 1995 Bill Clinton: 2 yr partnership of federal and state agencies, working together to protect
the healthcare trust funds through shared intelligence coordinated enforcement, intended to
enhance quality of care for program's beneficiaries.


Program is not called Senior Medicare Patrol SMP


They work to combat fraud and abuse.

SMP - answer✔✔Senior Medicare Patrol

OIG - answer✔✔Office of Inspector General

AoA - answer✔✔Administration on Aging

FCA - answer✔✔False Claims Act

CMPL - answer✔✔Civil Money Penalties Law

CMS Definition of Fraud - answer✔✔knowingly making false statements or misrepresenting
facts to obtain an undeserved benefit or payment from a federal healthcare program

CMS Definition of Abuse - answer✔✔an action resulting in unnecessary costs to a federal
healthcare program either directly or indirectly

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CMS Examples of Fraud - answer✔✔Billing for Services/Supplies that you know were not
furnished or provided


Altering claim forms and/or receipts to receive a higher payment amount


Billing for services at a level higher than provided or necessary


Misrepresenting the diagnosis to justify payment


Making referrals to certain designated services that are prohibited

CMS Examples of Abuse - answer✔✔Misusing codes on claims


Charging excessively for service or supplies


Billing for services that were not medically necessary


Failure to maintain adequate medical or financial records


Improper billing practices


Billing Medicare patients a higher fee schedule than non-medicare patients

FCA - answer✔✔Federal


False Claims Act

Lincoln Law - answer✔✔False Claims Act, enacted 1863 to combat fraud from suppliers of
good to the Union Army during the Civil War

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In 1943 amendments made it more difficult to bring action forward.


In 1986 Congress enacted an overhaul that generated new fraud investigations and actions.


The Statute is in title 31, subtitle III, CH. 37, subchapter III, of the US code 31 U.S.C. 3729(a).1

Title 31 Statute's 7 Types of Conduct - answer✔✔that brings liability FCA


It states a person is liable who:


A) Knowingly presents, or causes to be presented, a false or fraudulent claim for payment or
approval;


B) Knowingly makes , uses, or causes to be made or used, a false record or statement material to
a false or fraudulent claim

Title 31 Statute's 7 Types of Conduct - answer✔✔C) Conspires to a violation of subparagraph
(A), (B), (E), (F), or (G);


D) Has posession, custody, or control of property or money used, or to be used, by the
government and knowingly delivers, or causes to be delivered , less than all of that money or
property;

Title 31 Statute's 7 Types of Conduct - answer✔✔E) Is authorized to make or deliver a document
certifying receipt of property used, or to be used, by the government, and intending to defraud
the government, makes or delivers the receipt without completely knowing that the information
on the receipt is true


F) Knowingly buys or receives as a pledge of an obligation or debt, public property from an
officer or employee of the government or a member of the Armed Forces, who lawfully may not
sell or pledge property

Title 31 Statute's 7 Types of Conduct - answer✔✔G) Knowingly makes, uses, or causes to be
made or used, a false record or statement material to an obligation to pay or transmit money or

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