CPMA Exam Study Guide with Complete
Solutions
CMS Fraud Definition - Answer-Making false statements or misrepresenting
facts to obtain an undeserved benefit or payment from a federal healthcare program
CMS Abuse Definition - Answer-An action that results in unnecessary costs to a
federal healt...
List of Excluded Individuals/Entities (LEIE) - Answer✔✔-Produced and updated by
the OIG; provides information regarding individuals and entities currently excluded from
participation in Medicare, Medicaid, and all other federal healthcare programs; sorts
excluded individuals or entities by the legal basis for the exclusion, the types of
individuals and entities that have been excluded, and the states where the excluded
individual resided at the time they were excluded or the state in which the entity was
doing business
Civil Monetary Penalties Law - Answer✔✔-The Social Security Act authorizes the
HHS to seek civil monetary penalties and exclusion for certain behaviors. These
penalties are enforced by the OIG through the Civil Monetary Penalties (CMP) Law. The
severity of penalties and monetary amounts charged depend on the type of conduct
engaged in by the physician. A physician can incur a CMP in the following ways:
Presenting or causing claims to be presented to a federal healthcare program that the
person knows or should know is for an item or service that was not provided as claimed
or is false or fraudulent.Violating the Anti-Kickback Statute by knowingly and willfully (1)
offering or paying remuneration to induce the referral of federal healthcare program
business, or (2) soliciting or receiving remuneration in return for the referral of federal
healthcare program business. Knowingly presenting or causing claims to be presented
for a service for which payment may not be made under the Stark law
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