CPMA EXAM QUESTIONS AND ANSWERS

Fraud or Abuse: Billing for a service at a higher level than provided - Answer- Fraud What is a Qua Tam relator? - Answer- A person who brings a civil action for a violation for him/herself & for US Govt What is the difference between Stark Law & Antikickback law? - Answer- No INTENT must be provien for Stark, Antikickpack requires proof of intent When banned for Fed/State healthcare program, what is the term of exclusion (in Years)? - Answer- 5 years How often are the OIG workplans updated? - Answer- Monthly online The FCA allows for reduced penalties if the person committing the violation does what? - Answer- Self discloses Fraud or Abuse? Misrepresenting a DX to justify payment? - Answer- Fraud Fraud or Abus? Improper billing practices - Answer- Abuse Fraud or Abuse? Altering claim forms and/or receipts to receive a higher payment amount. - Answer- Fraud Fraud or Abuse? Billing Medicare patients a higher fee schedule compared to non-Medicare patients. - Answer- Abuse What does FCA stand for? - Answer- Federal False Claims Act How else is the Start Law referred? - Answer- Physician self-referral law How many federal OIGs are there? - Answer- 73 What is the CIA? - Answer- Corporate Integrity Agreements lasting typically 5 years as a guideline to help providers that have been excluded. When CIAs require claim reviews what is considered the DISCOVERY sample? - Answer- 50 claims randomly selected (95% accuracy required) What are the fundamental elements for an effective compliance program? - Answer- 1. Written policies 2. Compliance officer/committee 3. Training/education 4.