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CPMA Exam New /814 Questions And Answers
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CPMA Exam New 2023-2024 /814 Questions AndAnswers
Quiz :CMS Fraud Definition - Answer :Making false statements or
misrepresenting facts to obtain an undeserved benefit or payment from a
federal healthcare program
Quiz :CMS Abuse Definition - Answer :An action that results in unnecessary
costs to a federal healthcare program, either directly or indirectly
Quiz :CMS Examples of Fraud - Answer :Billing for services and/or supplies
that you know were not furnished or provided, altering claim forms and/or
receipts to receive a higher payment amount, billing a Medicare patient above
the allowed amount for services, billing for services at a higher level than
provided or necessary, misrepresenting the diagnosis to justify payment
Quiz :CMS Examples of Abuse - Answer :Misusing codes on a claim, charging
excessively for services or supplies, billing for services that were not medically
necessary, failure to maintain adequate medical or financial records, improper
billing practices, billing Medicare patients a higher fee schedule than non-
Medicare patients
Quiz :False Claims Act - Answer :Any person is liable if they knowingly present
or cause to be presented a false or fraudulent claim for payment or approval;
knowingly makes, uses, or causes to be made or used, a false record or
material to a false or fraudulent claims
Quiz :Current False Claims Act penalties - Answer :$5,500-$11,000 per claim
Quiz :When does the False Claims Act allow for reduced penalties? -
Answer :If the person committing the violation self-discloses and provides all
known info within 30 days, fully cooperates with the investigation, and there is
no criminal prosecution, civil action, or administrative action regarding the
violation
Quiz :Qui Tam or "Whistleblower" provision - Answer :If an individual (known
as a "relator") knows of a violation of the False Claims Act, he or she may bring
a civil action on behalf of him or herself and on behalf of the U.S. government;
the relator may be awarded 15-25% of the dollar amount recovered
, Quiz :Stark or Physician Self-Referral Law - Answer :Bans physicians from
referring patients for certain services to entities in which the physician or an
immediate family member has a direct or indirect financial relationship; bans
the entity from billing Medicare or Medicaid for the services provided as a
result of the self-referral
Quiz :Anti-Kickback Law - Answer :Similar to the Stark Law but imposes more
severe penalties; states that whoever knowingly or willfully solicits or receives
any remuneration in return for referring an individual to a person for the
furnishing or arranging of any item or service for which payment may be made
in whole or in part under a federal healthcare program or in return for
purchasing, leasing, ordering, or arranging for or recommending purchasing,
leasing, or ordering any good, facility, service, or item for which payment may
be made in whole or in part under a federal healthcare program is guilty of a
felony
Quiz :Penalty for violating the Anti-Kickback Law - Answer :Up to $25,000 fine
and/or imprisonment of up to 5 years
Quiz :Stark Law vs. Anti-Kickback Law - Answer :Anti-Kickback applies to
anyone, not just physicians; the Anti-Kickback Law requires proof of intention
and states that the person must "knowingly and willfully" violate the law.
Quiz :Exclusion Statute - Answer :Under the Exclusion Statute, a physician
who is convicted of a criminal offense—such as Medicare fraud (both
misdemeanor and felony convictions), patient abuse and neglect, or illegal
distribution of controlled substances—can be banned from participating in
Medicare by the OIG. Physicians who are excluded may not directly or
indirectly bill the federal government for the services they provide to Medicare
patients.
Quiz :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
, Quiz :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
Quiz :Amount of civil monetary penalties - Answer :Range from $10,000-
$50,000 per violation and an assessment of up to 3 times the amount of the
over-payments
Quiz :Reverse False Claims section of the False Claims Act - Answer :Final
section that provides liability where a person acts improperly to avoid paying
money owed to the government
Quiz :Examples of fraud/misconduct subject to the False Claims Act -
Answer :Falsifying a medical chart notation; submitting claims for services not
performed, not requested, or unnecessary; submitting claims for expired
drugs; upcoding and/or unbundling services; submitting claims for physician
services performed by a non-physician provider without regard to Incident-to
guidelines
Quiz :Exceptions to the Stark Law - Answer :General exceptions to both
ownership and compensation arrangement prohibitions (in-office ancillary
services); general exceptions related only to ownership or investment
prohibition for ownership in publicly traded securities and mutual funds
(services furnished by a rural provider); exceptions related to other
compensation arrangements (personal services arrangements and rental of
office space and equipment)
Quiz :Office of the Inspector General (OIG) - Answer :Detects and prevents
fraud, waste, and abuse and improves efficiency of HHS programs; most
, resources are directed toward the oversight of Medicare and Medicaid, but
also extend to the Centers for Disease Control and Prevention (CDC), National
Institutes of Health (NIH), and the Food and Drug Administration (FDA)
Quiz :OIG Work Plan - Answer :Published annually; lists the various projects
that will be addressed during the fiscal year by the Office of Audit Services,
Office of Evaluation and Inspections, Office of Investigations, and Office of
Counsel to the Inspector General; summarizes new and ongoing reviews and
activities that OIG plans to pursue during the next fiscal year and beyond
Quiz :Why should an auditor know what is in the OIG Work Plan for the
current year? - Answer :It allows an auditor to inform providers and facilities
of services or issues of which to be especially mindful in the coming year; may
be helpful in forming the scope of an audit for a provider or facility or may
influence recommendations given to a practice
Quiz :Corporate Integrity Agreements - Answer :Required by the OIG s a
condition of not seeking exclusion from participation when an individual or
entity seeks to settle civil healthcare fraud cases; typically last 5 yrs but can be
longer; most have the same core requirements along with specific steps for the
individual or entity that are related to the conduct that led to the settlement
Quiz :Core requirements in CIAs - Answer :Hiring a compliance
officer/appointing a compliance committee; developing written standards and
policies; implementing a comprehensive employee training program; retaining
an independent review organization (IRO) to conduct annual reviews;
establishing a confidential disclosure program; restricting employment of
ineligible persons; reporting overpayments, reportable events, and ongoing
investigations/legal proceedings; providing an implementation report and
annual reports to the OIG on the status of the entity's compliance activities
Quiz :Independent review organization (IRO) - Answer :Acts as a 3rd party
medical review resource that provides objective, unbiased audits and reports
Quiz :How many sampling units are selected for review in a Discovery Sample
under a CIA? - Answer :50
Quiz :Purpose of a Discovery Sample - Answer :Used to determine the net
financial error rate; if the error rate exceeds 5%, a Full Sample must be
reviewed, along with a Systems Review
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