CPMA Exam Chapter 5: Self-Disclosure Audits Study Guide
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Course
CPMA
Institution
CPMA
CPMA Exam Chapter 5: Self-Disclosure
Audits Study Guide
The OIG Self-Disclosure Protocol (SDP) provides the - Answer-ability to self-disclose
potential instances of fraud involving federal healthcare programs for which liability arises
under the OIG's civil money penalty authorities
The SDP (S...
If decision is made to either perform a 100% audit, or to audit a sample, the auditor will -
Answer✔✔-perform the actual analysis of the suspect claims to identify the existence of any
legally definable error.
In such a case, the auditor must be very clear in detailing the rational for any error or change in
code,
as well as to detail the financial impact associated with the auditor's conclusions (usually, on a
service-specific basis).
In addition to identifying the appropriate binding standards, where a change in code is the
result, the auditor may be asked to identify the appropriate - Answer✔✔-fee schedule
allowance in effect at the time, so that the specific financial impact associated with any
detected error can be identified and refunded.
In some cases, no auditing may be required - Answer✔✔-because the dollar value of an
overpayment can be identified through simple data analysis
AN EXAMPLE: A circumstance might be overpayment associated with non-conformance with
the incident-to rule
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