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CPMA Exam Questions and Answers (100% Pass)
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CPMA Exam Questions and Answers (100% Pass)
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1|Page | © copyright 2024/2025 | Grade A+CPMA Exam Questions and
Answers (100% Pass)
CMS Fraud Definition
✓ Making false statements or misrepresenting facts to obtain an
undeserved benefit or payment from a federal healthcare program
CMS Abuse Definition
✓ An action that results in unnecessary costs to a federal healthcare
program, either directly or indirectly
CMS Examples of Fraud
✓ Billing for services and/or supplies that you know were not furnished or
provided, altering claim forms and/or receipts to receive a higher
payment amount, billing a Medicare patient above the allowed
amount for services, billing for services at a higher level than provided
or necessary, misrepresenting the diagnosis to justify payment
CMS Examples of Abuse
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✓ Misusing codes on a claim, charging excessively for services 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
False Claims Act
✓ Any person is liable if they knowingly present or cause to be presented
a false or fraudulent claim for payment or approval; knowingly makes,
uses, or causes to be made or used, a false record or material to a
false or fraudulent claims
Current False Claims Act penalties
✓ $10,957-$21,916 per claim plus three times the amount of damages
When does the False Claims Act allow for reduced penalties?
✓ If the person committing the violation self-discloses and provides all
known info within 30 days, fully cooperates with the investigation, and
there is no criminal prosecution, civil action, or administrative action
regarding the violation
Qui Tam or "Whistleblower" provision
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✓ If an individual (known as a "relator") knows of a violation of the False
Claims Act, he or she may bring a civil action on behalf of him or
herself and on behalf of the U.S. government; the relator may be
awarded 15-25% of the dollar amount recovered
Stark or Physician Self-Referral Law
✓ Bans physicians from referring patients for certain services to entities in
which the physician or an immediate family member has a direct or
indirect financial relationship; bans the entity from billing Medicare or
Medicaid for the services provided as a result of the self-referral
Anti-Kickback Law
✓ Similar to the Stark Law but imposes more severe penalties; states that
whoever knowingly or willfully solicits or receives any remuneration in
return for referring an individual to a person for the furnishing or
arranging of any item or service for which payment may be made in
whole or in part under a federal healthcare program or in return for
purchasing, leasing, ordering, or arranging for or recommending
purchasing, leasing, or ordering any good, facility, service, or item for
which payment may 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
✓ Up to $25,000 fine and/or imprisonment of up to 5 years
Stark Law vs. Anti-Kickback Law
✓ Anti-Kickback applies to anyone, not just physicians; the Anti-Kickback
Law requires proof of intention and states that the person must
"knowingly and willfully" violate the law.
Penalties for the Stark Law
✓ Potential $15,000 CMP and civil assessment of up to three times the
amount claimed
Exclusion Statute
✓ Under the Exclusion Statute, a physician who is convicted of a criminal
offense—such as Medicare fraud (both misdemeanor and felony
convictions), patient abuse and neglect, or illegal distribution of
controlled substances—can be banned from participating in Medicare
by the OIG. Physicians who are excluded may not directly or indirectly
bill the federal government for the services they provide to Medicare
patients.
List of Excluded Individuals/Entities (LEIE)
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