2024 Medicare+ Fraud, Waste, And Abuse Already Rat
2024 Medicare+ Fraud, Waste, and Abuse Already Rat
Exam (elaborations)
2024 Medicare+ Fraud, Waste, and Abuse Already Rated A+
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2024 Medicare+ Fraud, Waste, and Abuse Already Rat
Institution
2024 Medicare+ Fraud, Waste, And Abuse Already Rat
2024 Medicare+ Fraud, Waste, and Abuse Already Rated A+
1. You are tasked with submitting a risk diagnosis to the Centers for Medicare & Medicaid Services
(CMS) for payment, and your supervisor tells you to ignore the Sponsor's process and adjust or add risk
diagnosis codes for certain indivi...
2024 Medicare+ Fraud, Waste, and Abuse Already Rated A+
1. You are tasked with submitting a risk diagnosis to the Centers for Medicare & Medicaid Services
(CMS) for payment, and your supervisor tells you to ignore the Sponsor's process and 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).
2. You are performing a regular inventory of the controlled substances in the pharmacy. You discover a
minor inventory discrepancy. What should you do?
- ✔️ Follow your pharmacy's procedures.
3. Which of the following requires intent to obtain payment and the knowledge the actions are wrong?
- ✔️ Fraud.
4. 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, while the beneficiary normally receives a quantity of 60.
You review the prescription and have concerns about possible forgery. What is your next step?
- ✔️ Call the prescriber to verify the quantity.
5. You are in charge of paying claims submitted by providers and notice that "Doe Diagnostics"
requested a substantial payment for a large patient group, with claims far exceeding other providers.
What should you do?
- ✔️ Consult with your immediate supervisor for next steps or contact the compliance department
(via compliance hotline, Special Investigations Unit [SIU], or other mechanism).
6. Which of the following is NOT potentially a penalty for violation of a law or regulation prohibiting
fraud, waste, and abuse (FWA)?
- ✔️ Deportation.
7. Examples of issues that should be reported to a Compliance Department include suspected fraud,
waste, and abuse (FWA); potential health privacy violations; unethical behavior; and employee
misconduct.
- ✔️ True.
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