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Fraud Waste and Abuse Exam Questions & Answers.
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Fraud Waste and Abuse Exam Questions & Answers.Fraud Waste and Abuse Exam Questions & Answers.
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Fraud Waste and Abuse Exam Questions &Answers.
ACA Section 1557 differs from earlier legislation in providing broader protection against
discrimination based on - ANS sex
Section 1557 of the Affordable Care Act applies to - ANS c. all health programs and
activities administered by or receiving federal financial assistance from HHS. Correct
Which Medicare programs are covered by ACA Section 1557? - ANS a. Parts A, C, and
D, but not B. Correct
Under ACA Section 1557, prohibited actions involve - ANS d. eligibility, claims, and
marketing. Correct
Under ACA Section 1557, a person - ANS c. cannot be discriminated against based on
her legal or illegal immigration status or ability to speak English. Correct
Under ACA Section 1557, a health plan - ANS d. cannot deny coverage to LEP
individuals and is required to provide language assistance to them, free of charge.
Correct
Which of these actions is most likely to be permitted in dealing with a person with limited
English proficiency? - ANS a. allowing a child to interpret in an emergency. Correct
Under ACA Section 1557, sex discrimination includes a person's - ANS c. sex,
pregnancy, sex stereotypes, or gender identity. Correct
Under ACA Section 1557, a health plan sold through a state exchange may, based on
an individual's age, - ANS d. charge higher premiums. Correct
ACA Section 1557 rules for disability concern - ANS d. Policies and procedures,
physical access, and communication. Correct
Which area of potential discrimination is not generally covered by ACA Section 1557? -
ANS c. Employment (with the exception of the provision of health insurance). Correct
As a result of violations of ACA Section 1557 nondiscrimination rules, - ANS c. a health
plan may revoke an agent or broker's appointment with the health plan. Correct
For a health plan, what are the possible consequences of violations of ACA Section
1557? - ANS b. Loss of federal business and compensatory damages. Correct
, If a health plan violates ACA Section 1557 nondiscrimination protections, it may be -
ANS c. required to take corrective action and sometimes pay damages, and it may be
sued by individuals. Correct
Ways to report potential Fraud, Waste, and Abuse (FWA) include: - ANS e. All of the
above Correct
Once a corrective action plan is started, the corrective actions must be monitored
annually to ensure they are effective. - ANS False
Any person who knowingly submits false claims to the Government is liable for five
times the Government's damages caused by the violator plus a penalty. - ANS False
These are examples of issues that should be reported to a Compliance Department:
suspected Fraud, Waste, and Abuse (FWA); potential health privacy violation, and
unethical behavior/employee misconduct. - ANS True
Bribes or kickbacks of any kind for services that are paid under a Federal health care
program (which includes Medicare) constitute fraud by the person making as well as the
person receiving them. - ANS True Correct
Waste includes any misuse of resources such as the overuse of services, or other
practices that, directly or indirectly, result in unnecessary costs to the Medicare
Program. - ANS True
You can help prevent Fraud, Waste, and Abuse (FWA) by doing all of the following:
• Look for suspicious activity;
• Conduct yourself in an ethical manner;
• Ensure accurate and timely data/billing;
• Ensure you coordinate with other payers;
• Keep up to date with FWA policies and procedures, standards of conduct, laws,
regulations, and the Centers for Medicare & Medicaid Services (CMS) guidance; and
• Verify all information provided to you. - ANS F
What are some of the penalties for violating Fraud, Waste, and Abuse (FWA) laws? -
ANS all of the above
Some of the laws governing Medicare Parts C and D Fraud, Waste, and Abuse (FWA)
include the Health Insurance Portability and Accountability Act (HIPAA); the False
Claims Act; the Anti-Kickback Statute; the List of Excluded Individuals and Entities
(LEIE); and the Health Care Fraud Statute. - ANS false
Abuse involves payment for items or services when there is no legal entitlement to that
payment and the provider has not knowingly and/or intentionally misrepresented facts to
obtain payment. - ANS false
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