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CE Mastery Exam - Medicare FWA, Top Exam Questions and answers, Verified.
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CE Mastery Exam - Medicare FWA, Top Exam Questions and answers, Verified. Your job is to submit a risk diagnosis to the Centers for Medicare & Medicaid Services (CMS) for the purpose of payment. As part of this job, you use a process to verify the data is accurate. Your immediate supervisor te...

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  • June 13, 2023
  • 7
  • 2022/2023
  • Exam (elaborations)
  • Questions & answers

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CE Mastery Exam - Medicare FWA, Top
Exam Questions and answers, Verified.

Your job is to submit a risk diagnosis to the Centers for Medicare & Medicaid Services (CMS) for the
purpose of payment. As part of this job, you use a process to verify the data is accurate. Your immediate
supervisor tells you to ignore the Sponsor's process and to adjust or add risk diagnosis codes for certain
individuals. What should you do?



a.Do what your immediate supervisor asked you to do and adjust or add risk diagnosis codes

b.Report the incident to the compliance department (via compliance hotline or other mechanism)

c.Discuss your concerns with your immediate supervisor

d.Call law enforcement - ✔✔-Report the incident to the compliance department (via compliance hotline
or other mechanism)



Which of the following is NOT potentially a penalty for violation of a law or regulation prohibiting fraud,
waste, and abuse (FWA)?



a.Civil Monetary Penalties

b.Exclusion from participation in all Federal health care programs

c.Deportatio - ✔✔-Deportation



Which of the following requires intent to obtain payment and the knowledge the actions are wrong?



a.Fraud

b.Waste

c.Abuse - ✔✔-Fraud



A person drops off a prescription for a beneficiary who is a "regular" customer. The prescription is for a
controlled substance with a quantity of 160. This beneficiary normally receives a quantity of 60, not 160.
You review the prescription and have concerns about possible forgery. What is your next step?

, a.Call law enforcement

b.Call the prescriber to verify the quantity

c.Call the Sponsor's compliance department

d.Fill the prescription for 160

e.Fill the prescription for 60 - ✔✔-Call the prescriber to verify the quantity



You are performing a regular inventory of the controlled substances in the pharmacy. You discover a
minor inventory discrepancy. What should you do?



a.Perform another review

b.Follow your pharmacy's procedures.

c.Call local law enforcement

d.Discuss your concerns with your supervisor

e.Contact your compliance department (via compliance hotline or other mechanism) - ✔✔-Follow your
pharmacy's procedures.



You are in charge of paying claims submitted by providers. You notice a certain diagnostic provider
("Doe Diagnostics") requested a substantial payment for a large number of members. Many of these
claims are for a certain procedure. You review the same type of procedure for other diagnostic providers
and realize Doe Diagnostics' claims far exceed any other provider you reviewed. What should you do?



a.Call Doe Diagnostics and request additional information for the claims

b.Consult with your immediate supervisor for next steps or contact the compliance department (via
compliance hotline, Special Investigations Unit [SIU], or other mechanism)

c.Pay the claims

d.Reject the claims - ✔✔-Consult with your immediate supervisor for next steps or contact the
compliance department (via compliance hotline, Special Investigations Unit [SIU], or other mechanism)



You discover an unattended email address or fax machine in your office receiving beneficiary appeals
requests. You suspect no one is processing the appeals. What should you do?

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