CPMA Exam Complete Questions And Answers With Latest Quiz
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Course
CPMA
Institution
CPMA
CPMA Exam Complete Questions And Answers With Latest Quiz
CPMA Exam Complete Questions And Answers With Latest Quiz
CPMA Exam Complete Questions And Answers With Latest Quiz
CPMA Exam Complete Questions And Answers With Latest Quiz
CPMA Exam Complete Questions And Answers With Latest Quiz
CPMA...
CPMA Exam Complete Questions And Answers With
Latest Quiz
CMS Fraud Definition - ANS-Making false statements or misrepresenting facts to obtain an
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n undeserved benefit or payment from a federal healthcare program
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CMS Abuse Definition - ANS-An action that results in unnecessary costs to a federal
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n healthcare program, either directly or indirectly
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CMS Examples of Fraud - ANS-Billing for services and/or supplies that you know were not
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n furnished or provided, altering claim forms and/or receipts to receive a higher payment
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n amount, billing a Medicare patient above the allowed amount for services, billing for
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n services at a higher level than provided or necessary, misrepresenting the diagnosis to
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n justify payment
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CMS Examples of Abuse - ANS-Misusing codes on a claim, charging excessively for services
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n or supplies, billing for services that were not medically necessary, failure to maintain
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n adequate medical or financial records, improper billing practices, billing Medicare
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n patients a higher fee schedule than non-Medicare patients
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False Claims Act - ANS-Any person is liable if they knowingly present or cause to be
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n presented a false or fraudulent claim for payment or approval; knowingly makes, uses, or
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n causes to be made or used, a false record or material to a false or fraudulent claims
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,Current False Claims Act penalties - ANS-$5,500-$11,000 per claim
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When does the False Claims Act allow for reduced penalties? - ANS-If the person
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n committing the violation self-discloses and provides all known info within 30 days, fully
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n cooperates with the investigation, and there is no criminal prosecution, civil action, or
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n administrative action regarding the violation n n n n
Qui Tam or "Whistleblower" provision - ANS-If an individual (known as a "relator") knows
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n of a violation of the False Claims Act, he or she may bring a civil action on behalf of him or
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n herself and on behalf of the U.S. government; the relator may be awarded 15-25% of the
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n dollar amount recovered
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Stark or Physician Self-Referral Law - ANS-Bans physicians from referring patients for
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n certain services to entities in which the physician or an immediate family member has a
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n direct or indirect financial relationship; bans the entity from billing Medicare or Medicaid
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n for the services provided as a result of the self-referral
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Anti-Kickback Law - ANS-Similar to the Stark Law but imposes more severe penalties;
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n states that whoever knowingly or willfully solicits or receives any remuneration in return
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n for referring an individual to a person for the furnishing or arranging of any item or
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n service for which payment may be made in whole or in part under a federal healthcare
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n program or in return for purchasing, leasing, ordering, or arranging for or recommending
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,n purchasing, leasing, or ordering any good, facility, service, or item for which payment may
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n be made in whole or in part under a federal healthcare program is guilty of a felony
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Penalty for violating the Anti-Kickback Law - ANS-Up to $25,000 fine and/or
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n imprisonment of up to 5 years n n n n n
Stark Law vs. Anti-Kickback Law - ANS-Anti-Kickback applies to anyone, not just
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n physicians; the Anti-Kickback Law requires proof of intention and states that the person
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n must "knowingly and willfully" violate the law.
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Exclusion Statute - ANS-Under the Exclusion Statute, a physician who is convicted of a
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n criminal offense—such as Medicare fraud (both misdemeanor and felony convictions),
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n patient abuse and neglect, or illegal distribution of controlled substances—can be banned
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n from participating in Medicare by the OIG. Physicians who are excluded may not directly
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n or indirectly bill the federal government for the services they provide to Medicare
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n patients.
List of Excluded Individuals/Entities (LEIE) - ANS-Produced and updated by the OIG;
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n provides information regarding individuals and entities currently excluded from
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n participation in Medicare, Medicaid, and all other federal healthcare programs; sorts
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n excluded individuals or entities by the legal basis for the exclusion, the types of
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n individuals and entities that have been excluded, and the states where the excluded
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, n individual resided at the time they were excluded or the state in which the entity was
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n doing business
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Civil Monetary Penalties Law - ANS-The Social Security Act authorizes the HHS to seek
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n civil monetary penalties and exclusion for certain behaviors. These penalties are enforced
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n by the OIG through the Civil Monetary Penalties (CMP) Law. The severity of penalties and
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n monetary amounts charged depend on the type of conduct engaged in by the physician. A
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n physician can incur a CMP in the following ways: Presenting or causing claims to be
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n presented to a federal healthcare program that the person knows or should know is for
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n an item or service that was not provided as claimed or is false or fraudulent.Violating the
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n Anti-Kickback Statute by knowingly and willfully (1) offering or paying remuneration to
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n induce the referral of federal healthcare program business, or (2) soliciting or receiving
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n remuneration in return for the referral of federal healthcare program business.
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n Knowingly presenting or causing claims to be presented for a service for which payment
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n may not be made under the Stark law
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Amount of civil monetary penalties - ANS-Range from $10,000-$50,000 per violation and
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n an assessment of up to 3 times the amount of the over-payments
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Reverse False Claims section of the False Claims Act - ANS-Final section that provides
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n liability where a person acts improperly to avoid paying money owed to the government
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