CPMA Questions And Answers
What action would be considered fraud rather than abuse? A provider requiring the coding
staff to intentionally code E/M services one level higher than documented.
The OIG Work Plan is divided into seven elements. Which option is a part of the OIG Work Plan
most applicable to physician services? Medicare Part A and Part B
A provider consistently charges a higher level of E/M service than is documented to help cover
the cost of his declining practice. Would this be fraud or abuse, and why? Fraud; the
provider intentionally over-coded to gain financially. The different between fraud and abuse is
intent
Based on the compliance program guidance documents by the OIG, what should be documented
when non-compliant conduct is found? Any finding of non-compliant conduct must be
documented in the compliance files and should include: date of incident, name of the reporting
party, name of the person responsible for taking action, the follow-up action taken
The OIG lists potential risk areas for individual and small physician groups in the compliance
plan guidance. Which option below is listed as a risk area? Unbundling; The OIG
, CPMA Questions And Answers
Compliance Guidance for Individual and Small Group Physician Practices lists unbundling as a
potential risk area among others
What is another name for the Federal False Claims Act (FCA)? Lincoln Law
Which statement is TRUE regarding 1995 and 1997 E/M Documentation Guidelines? The
1997 E/M Documentation Guidelines are more detailed using bullets and shading to determine
levels of exams.
What rights does a provider have if he/she disagrees with a demand letter sent by the OIG?
If the subject receiving a demand letter from the OIG disagrees, he/she can request a
hearing before an administrative law judge (ALJ) in Health and Human Services (HHS).
Which one of the following options is NOT a requirement for financial penalties to be mitigated
in a federal False Claims Act case? The FCA allows for reduced penalties (mitigation) if
the person committing the violation self-discloses. §3729 a.2 states that the court may assess not
less than two times the amount of damages (as opposed to three times), which the government
sustains because of the act of that person, if:(A)the person responsible furnishes officials of the
United States responsible for investigating false claims violations with all information known to
such person about the violation within 30 days after the date on which the defendant first
obtained the information;(B) such person fully cooperates with the investigation of such
What action would be considered fraud rather than abuse? A provider requiring the coding
staff to intentionally code E/M services one level higher than documented.
The OIG Work Plan is divided into seven elements. Which option is a part of the OIG Work Plan
most applicable to physician services? Medicare Part A and Part B
A provider consistently charges a higher level of E/M service than is documented to help cover
the cost of his declining practice. Would this be fraud or abuse, and why? Fraud; the
provider intentionally over-coded to gain financially. The different between fraud and abuse is
intent
Based on the compliance program guidance documents by the OIG, what should be documented
when non-compliant conduct is found? Any finding of non-compliant conduct must be
documented in the compliance files and should include: date of incident, name of the reporting
party, name of the person responsible for taking action, the follow-up action taken
The OIG lists potential risk areas for individual and small physician groups in the compliance
plan guidance. Which option below is listed as a risk area? Unbundling; The OIG
, CPMA Questions And Answers
Compliance Guidance for Individual and Small Group Physician Practices lists unbundling as a
potential risk area among others
What is another name for the Federal False Claims Act (FCA)? Lincoln Law
Which statement is TRUE regarding 1995 and 1997 E/M Documentation Guidelines? The
1997 E/M Documentation Guidelines are more detailed using bullets and shading to determine
levels of exams.
What rights does a provider have if he/she disagrees with a demand letter sent by the OIG?
If the subject receiving a demand letter from the OIG disagrees, he/she can request a
hearing before an administrative law judge (ALJ) in Health and Human Services (HHS).
Which one of the following options is NOT a requirement for financial penalties to be mitigated
in a federal False Claims Act case? The FCA allows for reduced penalties (mitigation) if
the person committing the violation self-discloses. §3729 a.2 states that the court may assess not
less than two times the amount of damages (as opposed to three times), which the government
sustains because of the act of that person, if:(A)the person responsible furnishes officials of the
United States responsible for investigating false claims violations with all information known to
such person about the violation within 30 days after the date on which the defendant first
obtained the information;(B) such person fully cooperates with the investigation of such
