You can help prevent Fraud, Waste, and Abuse (FA) by doing all of the following:
Look for suspicious activity;
Conduct yourself in an ethical manner;
Ensure accurate and timely data/billing;
Ensure you coordinate with other payers;
Keep up to date with FA policies and procedures, standards of ...
Medicare Fraud & Abuse Exam
Questions and Answers
You can help prevent Fraud, Waste, and Abuse (FA) by doing all of the following:
Look for suspicious activity;
Conduct yourself in an ethical manner;
Ensure accurate and timely data/billing;
Ensure you coordinate with other payers;
Keep up to date with FA policies and procedures, standards of conduct, laws,
regulations, and the Centers for Medicare & Medicaid Services (CMS) guidance; and
Verify all information provided to you. - Answer-True
A provider who violates the Civil False Claims Act may have to pay a Civil Monetary
Penalty (CMP) of $20,000 for each false claim. - Answer-False
Abuse involves payment for items or services when there is no legal entitlement to that
payment and the provider has not knowingly and/or intentionally misrepresented facts to
obtain payment. - Answer-True
You do not play a vital role in protecting the integrity of the Medicare and to prevent
fraud and abuse. - Answer-False
Some of the laws governing Medicare Parts C and D Fraud and Abuse (FA) include the
False Claims Act; the Anti-Kickback Statute; the List of Excluded Individuals and
Entities (LEIE); and the Health Care Fraud Statute. - Answer-False
Bribes or kickbacks of any kind for services that are paid under a Federal health care
program (which includes Medicare) constitute fraud by the person making as well as the
person receiving them. - Answer-True
These are examples of issues that should be reported to a Compliance Department:
suspected Fraud and Abuse (FA); potential health privacy violation, and unethical
behavior/employee misconduct. - Answer-True
Ways to report potential Fraud and Abuse (FA) include: - Answer-Telephone hotlines
Mail drops
In-person reporting to the compliance department/supervisor
Special Investigations Units (SIUs)
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