Health fraud - Study guides, Class notes & Summaries

CSPR - Certified Specialist Payment Rep (HFMA) Questions and Answers 2023 Steps used to control costs of managed care include: Bundled codes Capitation Payer and Provider to agree on reasonable payment DRG is used to classify Inpatient admissions for the purpose of reimbursing hospitals for each case in a given category w/a negotiated fixed fee, regardless of the actual costs incurred Identify the various types of private health plan coverage HMO Conventional PPO and POS H...

Compliance is the responsibility of the Compliance Officer, Compliance Committee, and Upper Management only. - False Ways to report a compliance issue include: a. Telephone hotlines b. Report on the Sponsor's website c. In-person reporting to the compliance department/supervisor d. All of the above - d. All of the above What is the policy of non-retaliation? a. Allows the Sponsor to discipline employees who violate the Code of Conduct b. Prohibits management and supervisor from harassi...

CA Optometry Law (M/PO/DA/F + UC)Compl Refusing to provide services because of race, color, sex, religion, ancestry, disability, marital status, or national origin - ANSWER Subject to disciplinary action (Ch1 Sec 125.6) Dispensing, prescribing, or selling eye glasses not made of shatter-resistant lenses or non-flammable frames to a one-eyed person, law enforcement officer, fireman, or person <18 yo - ANSWER Subject to disciplinary action (Art2) AND unprofessional conduct Sexual abuse,...

Adjuster Pro Texas with Complete Questions and Answers 100% VerifiedAdjuster Pro Texas with Complete Questions and Answers 100% VerifiedAdjuster Pro Texas with Complete Questions and Answers 100% VerifiedAdjuster Pro Texas with Complete Questions and Answers 100% Verified All of the following pieces of information can be found in the conditions section of an insurance policy EXCEPT: - ANSWER-Causes of loss that are not covered Which of the following best defines the principle of indemnity? -...

Steps used to control costs of managed care include: - ANSWER-Bundled codes Capitation Payer and Provider to agree on reasonable payment DRG is used to classify - ANSWER-Inpatient admissions for the purpose of reimbursing hospitals for each case in a given category w/a negotiated fixed fee, regardless of the actual costs incurred Identify the various types of private health plan coverage - ANSWER-HMO Conventional PPO and POS HDHP/SO plans - high-deductible health plans with a savings...

duty-based ethics Individual is expected to do the right thing cause it's the right thing to do, regardless of outcome utalitarian ethics Sells the optimal result for the greatest number of people Advisory note Punishment for a technical breach Administrative penalty/ fine One or two potentially serious infraction would cause this punishment Ratification- acting without authority or in excess of authority Implication- advice outside of objective These two ways of creating ...

outside vendor correct answersCardinal, order Sunday through Thursday, deliver Monday through Friday, available includes regular Rx items and narcotics and CIII-CV and special order OTCs, check in control and OTC piece by piece, CII checked in by pharmacy, rapid scanning will update boh automatically PHI correct answerspersonal health information, any information about a patient HIPPA correct answershealth insurance portability and accountability act, privacy pick correct answersoffer c...

Board of Psychology Members - ANSWER-Seven people appointed by governor and confirmed by the Senate. Five members must be psychologists licensed in Florida who are in good standing. Two members must be citizens of the state who are not and have never been psychologists. No connection to psychology. One member must be 60+ y/o. Appointed for four years and shall serve until their successors are appointed. Licensure Requirements - ANSWER-1) Doctoral-level psychological education or the equivalen...

CPCO EXAM REVIEW QUESTIONS AND ANSWERS, 100% ACCURATE. VERIFIED. The OIG consists of 6 departments: - -1.Immediate OIG — responsible for the overall fulfillment of the OIG's mission and for promoting effective management and quality of the agency's processes and products. 2.Office of Audit Services — performs independent audits of HHS programs and/or HHS grantees and contractors to examine their performance. 3.Office of Evaluation and Inspections — conducts national evaluations...

True or False: The ACA requires that all providers adopt a compliance plan as a condition of enrollment with Medicare, Medicaid, and Children's Health Insurance Program (CHIP). - Answer- True ref. ACA section 6102 According to HHS-OIG - what are three important reasons for proper documentation in Compliance? (hint: protections) - Answer- 1.Protect our programs 2.Protect your patients 3.Protect the Provider At which level of the Medicare Part A or Part B appeals process is the app...