Fwa medicare fraud - Study guides, Class notes & Summaries

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? Report the incident to the compliance department (via compliance hotline or other mechanism) You are performing a regular inventory of the contro...

CPCO EXAM REVIEW QUESTIONS AND ANSWERS, 100% ACCURATE. VERIFIED. The OIG consists of 6 departments: - -1.Immediate OIG — responsible for the overall fulfillment of the OIG's mission and for promoting effective management and quality of the agency's processes and products. 2.Office of Audit Services — performs independent audits of HHS programs and/or HHS grantees and contractors to examine their performance. 3.Office of Evaluation and Inspections — conducts national evaluations o...

UNITED HEALTHCARE (UHC) – ETHICS AND COMPLIANCE LATEST 2023-2024 EXAM| ACTUAL QUESTIONS AND VERIFIED ANSWERS |A+ GRADE Q: Agent Jacob learns that Emily, the consumer with whom he is meeting, is the authorized legal representative for her father. What must Jacob explain to Emily when completing an Enrollment Application for her father? Answer: Jacob must explain that Emily will sign the Enrollment Application and must be able to provide documentation upon request by the Plan that indic...

UNITED HEALTHCARE (UHC) – ETHICS AND COMPLIANCE LATEST 2023-2024 EXAM| ACTUAL QUESTIONS AND VERIFIED ANSWERS Version 2 |A+ GRADE Q: John has Power of Attorney to act on behalf of his mother. What does that mean when it comes to his mother enrolling in a Medicare Advantage Plan? Answer: John may sign the Enrollment Application and must be able to provide documentation upon request by the Plan that indicates his authority under state law to enroll his mother. Q: In which of the...

AHIP TRAINING Medicare Fraud, Waste, and Abuse Training EXAM 50+ QUESTIONS AND VERIFIED CORRECT ANSWERS 2023. AHIP TRAINING Medicare Fraud, Waste, and Abuse Training 1. Medicare plan means: A MA plan, MA-PD plan or PDP 2. Subcontractor means: **An individual or entity that provides services on behalf of a Medicare plan sponsor. This includes individuals and organizations with DIRECT relationship with the plan sponsor or individuals or organizations with INDIRECT relationship, such as ...

True or False: The ACA requires that all providers adopt a compliance plan as a condition of enrollment with Medicare, Medicaid, and Children's Health Insurance Program (CHIP). - Answer- True ref. ACA section 6102 According to HHS-OIG - what are three important reasons for proper documentation in Compliance? (hint: protections) - Answer- 1.Protect our programs 2.Protect your patients 3.Protect the Provider At which level of the Medicare Part A or Part B appeals process is the app...

AHIP 2025 Exam Prep| Qs & As| 100% Correct| Grade A (Verified Answers) Q: At a minimum, an effective compliance program includes four core requirements. Answer: False Q: What are some of the consequences for non-compliance, fraudulent, or unethical behavior? Answer: All of the above Q: Correcting non-compliance________. Answer: Protects enrollees, avoids recurrence of same non-compliance, and promotes efficiency Q: What is the policy of non-retaliation...

AHIP TRAINING Medicare Fraud, Waste, and Abuse Training Practice Questions and Answers 100% Pass Medicare plan means - Correct Answer ️️ -A MA plan, MA-PD plan or PDP Subcontractor means - Correct Answer ️️ -**An individual or entity that provides services on behalf of a Medicare plan sponsor. This includes individuals and organizations with DIRECT relationship with the plan sponsor or individuals or organizations with INDIRECT relationship, such as an agent who has a contract wit...

AHIP TRAINING Medicare Fraud, Waste, and Abuse Training Practice Questions and Answers 100% Pass Medicare plan means - Correct Answer ️️ -A MA plan, MA-PD plan or PDP Subcontractor means - Correct Answer ️️ -**An individual or entity that provides services on behalf of a Medicare plan sponsor. This includes individuals and organizations with DIRECT relationship with the plan sponsor or individuals or organizations with INDIRECT relationship, such as an agent who has a contract wit...

AHIP fraud waste & abuse questions and answers already passed Which of the following requires intent to obtain payment and the knowledge that the actions are wrong? Fraud Which of the following is not potentially a penalty for violation of the law or regulation prohibiting fraud, waste and abuse (fwa)? Deportation A person comes into your pharmacy to drop off a prescription for a beneficiary who is a regular customer. The prescription is for a controlled substance with a quantity of 160. This...