Question 1

Assigning diagnostic and procedural codes to obtain better reimbursement alone is _____.

Accepted Answer

A)   Helpful
B)   Necessary
C)   Permitted
D)   UnethicalE) A) and D)
F) B) and C)

Question 2

Which government agency's authority extends beyond the jurisdiction of other government programs?

Accepted Answer

A)   DCIS
B)   FBI
C)   FCA
D)   OIGE) A) and C)
F) B) and C)

Question 3

Which are examples of DHHS OIG programs implemented to educate entities about proper claims submission?

Accepted Answer

A)   CCI
B)   FCA
C)   PHI
D)   RICOE) B) and C)
F) B) and D)

Question 4

Kickback violations occur when a(n)  _____.

Accepted Answer

A)   Physician refers patients to a facility in which he holds a financial interest
B)   Provider receives compensation for patient referrals to a specific facility
C)   Third-party payers reimburse facilities and physicians for overbilled services
D)   Surgical procedure is coded at a higher level to increase financial compensationE) None of the above
F) A) and B)

Question 5

During the investigation of allegations of suspected fraud and abuse, when a government agent presents with a search warrant for patient records, the health information manager _____.

Accepted Answer

A)   Collects all records and answers any additional questions asked by the agent
B)   Has a duty to cooperate with the agent and must notify facility legal counsel
C)   Is prohibited from notifying legal counsel if also served with a court order
D)   Rejects the advice of legal counsel if the government agent instructs as suchE) B) and C)
F) A) and C)

Question 6

What are financial settlements or arrangements that specify rules of conduct to be followed to remedy any fraud and abuse found plus any monitoring and reporting requirements?

Accepted Answer

A)   Anti-kickback statutes
B)   Corporate integrity agreements
C)   Permissive/mandatory exclusions
D)   Qui tam actionsE) B) and C)
F) None of the above

Question 7

The DHHS Office of the Inspector General (OIG)  is _____.

Accepted Answer

A)   Authorized to conduct civil and criminal investigations of fraud associated with Medicare
B)   Not allowed to guide healthcare providers on how to comply with applicable laws and regulations
C)   Permitted to investigate claims of fraud and abuse and prohibited from investigating overpayments
D)   Simply a figurehead office that wields little or no effect on healthcare fraud and abuse violationsE) A) and D)
F) C) and D)

Question 8

The 48-hour project focused on the payments made to hospitals for services provided to patients within a three-day window of the patient's admission.

Accepted Answer

A) True 
 B)False

Question 9

The Center for Medicare and Medicaid Services PEPP program _____.

Accepted Answer

A)   Automates audits to reduce intentional fraud
B)   Clarifies DHHS OIG regulations
C)   Promotes the national correct coding initiative
D)   Reduces Medicare payment error ratesE) C) and D)
F) A) and B)

Question 10

A qui tam action is defined as _____.

Accepted Answer

A)   Any action brought against a healthcare facility or provider by a third-party payer or third-party administrator
B)   Government entity that sue on behalf of a private plaintiff to receive a portion of the recovered funds
C)   Private plaintiffs who sue on behalf of the U.S. government and who receive a portion of the recovered funds
D)   The prosecution of fraud and abuse, which results in governments receiving a portion of recovered fundsE) None of the above
F) A) and B)

Question 11

According to the AMA, it is ethical for a physician to hold a financial interest in a health care facility when the physician's _____.

Accepted Answer

A)   Arrangement with payers results in payment to patients
B)   Facility is the only one available in the immediate region
C)   Financial interest is disclosed to those referred for services
D)   Patients are insured so payment for services is guaranteedE) B) and C)
F) B) and D)

Question 12

Which usually involves a qui tam action?

Accepted Answer

A)   FCA claim
B)   HIPAA violation
C)   Negligent action
D)   Stark lawsE) B) and C)
F) A) and B)

Question 13

Stark I and Stark II laws were passed because _____.

Accepted Answer

A)   False misrepresentations of facts that were relied upon by another were a detriment to others and a departure from reasonable use
B)   Increased federal scrutiny caused healthcare organizations to change their methods of operation, such as submitting false claims
C)   Physicians were abusing the healthcare system by referring patients to services in which they (or family members)  had a financial interest
D)   Relators were suing on behalf of the U.S. government expressly to receive a portion of the recovered funds if the lawsuit was successfulE) A) and D)
F) None of the above

Question 14

Which changed the nature of compliance programs for some institutions from voluntary to mandatory and provided a financial incentive for states to adopt laws similar to federal laws regarding fraud and abuse?

Accepted Answer

A)   Deficit Reduction Act
B)   False Claims Act
C)   HIPAA
D)   Stark I and Stark IIE) None of the above
F) A) and B)

Question 15

Compliance programs ensure the establishment of effective internal controls that promote adherence to the applicable local, state and federal laws and regulations.

Accepted Answer

A) True 
 B)False

Question 16

In the context of billing fraud, upcoding is submitting a bill for a higher level of reimbursement than actually rendered in order to receive _____.

Accepted Answer

A)   financial kickbacks from payers
B)   higher reimbursement rates
C)   provider referrals for compensation
D)   Stark law monetary incentivesE) A) and D)
F) A) and B)

Question 17

An ethics-based compliance program conforms to applicable laws through _____ because it is the right thing to do or because a cost-benefit analysis reveals it would be a sound business practice.

Accepted Answer

A)   Efforts to avoid punishment if found guilty of violating standards
B)   Law enforcement and prosecution of those suspected of wrongdoing
C)   Mandatorily imposed accreditation standards and policies/procedures
D)   Voluntary compliance with local, state and federal laws and regulationsE) A) and D)
F) C) and D)

Exam 14: Health-Care Fraud and Abuse

An ethics-based compliance program conforms to applicable laws through _____ because it is the right thing to do or because a cost-benefit analysis reveals it would be a sound business practice.

Correct Answer
verified

Which government agency's authority extends beyond the jurisdiction of other government programs?

Correct Answer
verified

What are financial settlements or arrangements that specify rules of conduct to be followed to remedy any fraud and abuse found plus any monitoring and reporting requirements?

Correct Answer
verified

Compliance programs ensure the establishment of effective internal controls that promote adherence to the applicable local, state and federal laws and regulations.

Correct Answer
verified

Kickback violations occur when a(n) _____.

Correct Answer
verified

Stark I and Stark II laws were passed because _____.

Correct Answer
verified

Which are examples of DHHS OIG programs implemented to educate entities about proper claims submission?

Correct Answer
verified

In the context of billing fraud, upcoding is submitting a bill for a higher level of reimbursement than actually rendered in order to receive _____.

Correct Answer
verified

Which changed the nature of compliance programs for some institutions from voluntary to mandatory and provided a financial incentive for states to adopt laws similar to federal laws regarding fraud and abuse?

Correct Answer
verified

During the investigation of allegations of suspected fraud and abuse, when a government agent presents with a search warrant for patient records, the health information manager _____.

Correct Answer
verified

The Center for Medicare and Medicaid Services PEPP program _____.

Correct Answer
verified

Assigning diagnostic and procedural codes to obtain better reimbursement alone is _____.

Correct Answer
verified

The DHHS Office of the Inspector General (OIG) is _____.

Correct Answer
verified

The 48-hour project focused on the payments made to hospitals for services provided to patients within a three-day window of the patient's admission.

Correct Answer
verified

Which usually involves a qui tam action?

Correct Answer
verified

According to the AMA, it is ethical for a physician to hold a financial interest in a health care facility when the physician's _____.

Correct Answer
verified

A qui tam action is defined as _____.

Correct Answer
verified

Exam 14: Health-Care Fraud and Abuse

An ethics-based compliance program conforms to applicable laws through _____ because it is the right thing to do or because a cost-benefit analysis reveals it would be a sound business practice.

Correct AnswerverifiedShow Answer

Which government agency's authority extends beyond the jurisdiction of other government programs?

Correct AnswerverifiedShow Answer

What are financial settlements or arrangements that specify rules of conduct to be followed to remedy any fraud and abuse found plus any monitoring and reporting requirements?

Correct AnswerverifiedShow Answer

Compliance programs ensure the establishment of effective internal controls that promote adherence to the applicable local, state and federal laws and regulations.

Correct AnswerverifiedShow Answer

Kickback violations occur when a(n) _____.

Correct AnswerverifiedShow Answer

Stark I and Stark II laws were passed because _____.

Correct AnswerverifiedShow Answer

Which are examples of DHHS OIG programs implemented to educate entities about proper claims submission?

Correct AnswerverifiedShow Answer

In the context of billing fraud, upcoding is submitting a bill for a higher level of reimbursement than actually rendered in order to receive _____.

Correct AnswerverifiedShow Answer

Which changed the nature of compliance programs for some institutions from voluntary to mandatory and provided a financial incentive for states to adopt laws similar to federal laws regarding fraud and abuse?

Correct AnswerverifiedShow Answer

During the investigation of allegations of suspected fraud and abuse, when a government agent presents with a search warrant for patient records, the health information manager _____.

Correct AnswerverifiedShow Answer

The Center for Medicare and Medicaid Services PEPP program _____.

Correct AnswerverifiedShow Answer

Assigning diagnostic and procedural codes to obtain better reimbursement alone is _____.

Correct AnswerverifiedShow Answer

The DHHS Office of the Inspector General (OIG) is _____.

Correct AnswerverifiedShow Answer

The 48-hour project focused on the payments made to hospitals for services provided to patients within a three-day window of the patient's admission.

Correct AnswerverifiedShow Answer

Which usually involves a qui tam action?

Correct AnswerverifiedShow Answer

According to the AMA, it is ethical for a physician to hold a financial interest in a health care facility when the physician's _____.

Correct AnswerverifiedShow Answer

A qui tam action is defined as _____.

Correct AnswerverifiedShow Answer

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