Exam (elaborations)
MEDICARE EXAM - PART C & D - FRAUD, WASTE AND ABUSE EXAM 2024/2025
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MEDICARE EXAM - PART C & D - FRAUD, WASTE AND ABUSE EXAM 2024/2025
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MEDICARE EXAM - PART C & D - FRAUD,WASTE AND ABUSE EXAM 2024/2025
FWA training must occur within 90 days of one's initial hire and at least annually thereafter - Precise
Answer ✔✔
What is FWA? - Precise Answer ✔✔
Fraud
knowingly and willingly executing or attempting to execute.
a scheme or artifice to defraud any health care benefit program
or, to obtain, by means of false or fraudulent pretenses, representations, or promises any of the money
or property owned by, or under the custody or control of, any health care benefit program. - Precise
Answer ✔✔
The Health Care Fraud Statute
makes it a criminal offense to knowingly and willfully execute a scheme to defraud a health care benefit
program. - Precise Answer ✔✔
Health care fraud is punishable by imprisonment up to 10 years.
Also, subject to criminal fines up to 250,000. - Precise Answer ✔✔
Waste
Includes practice that directly or indirectly result in unnecessary costs to the Medicare program, such as
overusing services. Waist is generally not consider to be caused by criminally negligent actions but
better by the miss use of resources - Precise Answer ✔✔
,Abuse
Includes actions that me directly or indirectly. Result in unnecessary costs to the Medicare program.
Abuse involves paying for items or services when there is no Lico entitlement to that payment and the
provider has not knowing Lee are intentionally miss represent it faxed to obtain payment - Precise
Answer ✔✔
Examples of FWA
Fraud
Examples of actions that may constitute Medicare fraud include
Knowingly billing for services no furnished or supplies not provided including billing Medicare for
appointments the patient fell to keep
Billing for non-existent prescriptions
Knowingly altering claim forms medical records or receipts to receive a higher payment - Precise Answer
✔✔
Examples of FWA
Examples of actions that may constitute Medicare waste include
Conducting excessive office visits or writing excessive prescriptions
Prescribing more medication's than necessary for the treatment of a specific condition
Ordering excessive laboratory tests - Precise Answer ✔✔
, Examples of FWA
Examples of actions that may constitute Medicare abuse include
Unknowingly billing for all necessary medical services
Unknowingly billing for a brand-name drugs one generic are dispensed
Unknowingly charging excessively for services or supplies
Unknowingly miss using codes on a claim such as upcoding for unbundling codes - Precise Answer ✔✔
Differences among fraud waste and abuse
There are differences among fraud waste and abuse one of the primary differences is intent and
knowledge
Fraud requires intent to obtain payment and acknowledge the actions are wrong
Waste and abuse may involve obtaining an improper payment for creating and all necessary cost to the
Medicare program I do not require the same in tent and knowledge - Precise Answer ✔✔
Understanding FWA
To detect FWA you need to know the law
Civil false claims act healthcare Frost statues the criminal fraud
Anti-kickback statute
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