Question 1

Match the examples of fraud and abuse with the appropriate type.
Mistakenly sequencing codes out of order

Accepted Answer

Mistakenly sequencing codes out of order is an example of abuse, which refers to practices that are inconsistent with accepted sound medical, business, or fiscal practices. This is different from fraud, which involves intentional deception or misrepresentation for financial gain.

Question 2

Which allows private plaintiffs to sue on behalf of the U.S government and, as a result, receive a portion of the recovered funds if the case is successful?

Accepted Answer

Qui tam actions, also known as whistleblower lawsuits, allow private individuals to file lawsuits on behalf of the government against individuals or companies who have defrauded the government. If the case is successful, the private plaintiff is entitled to a portion of the recovered funds as a reward.

Question 3

Federal anti-kickback statutes prohibit providers from receiving or offering money in exchange for patient Medicare and Medicaid referrals to another provider of medical services.Most state antikickback statutes also include _____, which means they can be charged with a crime under the statutes.

Accepted Answer

C

Question 4

HIPAA modified the _____ to create penalties for unbundling, upcoding, billing for medically unnecessary services, and so on.

Accepted Answer

HIPAA modified the civil money penalty law to create penalties for unbundling, upcoding, billing for medically unnecessary services, and other fraudulent activities.

Question 5

Match the type of facility or service with the appropriate law.
Occupational and physical therapy practices

Accepted Answer

Stark II addresses referrals for designated health services (DHS), which includes physical and occupational therapy, while Stark I mainly focuses on physician self-referrals.

Question 6

Efforts to establish a culture that promotes prevention, detection, and resolution of instances of conduct that do not conform to application local, state, and federal laws is called _____.

Accepted Answer

Compliance refers to actively promoting adherence to all applicable laws, regulations, and internal policies through the development of a culture and system that values ethical behavior and adherence to rules. This includes efforts to prevent, detect, and resolve instances of non-compliance or misconduct. Fraud and qui tam are specific types of non-compliance, while regulation refers to the set of rules and guidelines established by governing bodies.

Question 7

Match the type of facility or service with the appropriate law.
Stand-alone radiology facilities

Accepted Answer

Stark II applies to a broader range of services, including radiology, and prohibits physician referrals to entities with which they have a financial relationship.

Question 8

Match the examples of fraud and abuse with the appropriate type.
Upcoding and unbundling codes

Accepted Answer

Upcoding and unbundling codes are considered fraud because they involve intentionally misrepresenting services provided to receive higher reimbursement.

Question 9

Match the examples of fraud and abuse with the appropriate type.
Charging for procedures that were not performed

Accepted Answer

Charging for procedures that were not performed is an intentional deception with the intent of receiving payment, which is classified as fraud.

Question 10

Which is the penalty for felony violation of mail and wire fraud statutes?

Accepted Answer

The answer of Which is the penalty for felony violation...

Question 11

Federal and state government health programs and third-party payers lose _____ of dollars annually due to intentional fraudulent actions and poor coding practices.

Accepted Answer

The answer of Federal and state government health programs and...

Question 12

Corporate integrity agreements that are part of a financial settlement agreement with the federal government in a fraud and abuse case are _____.

Accepted Answer

Corporate integrity agreements are written agreements that specify rules of conduct that healthcare providers or organizations must follow in order to participate in Medicare, Medicaid, and other federal healthcare programs. These agreements are often part of a financial settlement agreement with the federal government in a fraud and abuse case. They are intended to promote compliance with applicable laws and regulations and to prevent future misconduct. The agreements are usually negotiated by the Office of Inspector General of the Department of Health and Human Services.

Question 13

Which software technology is most commonly associated with combating fraud and abuse?

Accepted Answer

The answer of Which software technology is most commonly associated...

Question 14

Match the type of facility or service with the appropriate law.
Durable medical equipment companies

Accepted Answer

Stark II law prohibits physicians from referring patients to entities in which they or their family members have financial interest for designated health services, including durable medical equipment.

Question 15

Match the type of facility or service with the appropriate law.
Clinical laboratories

Accepted Answer

Clinical laboratories are covered under Stark I.

Question 16

Match the examples of fraud and abuse with the appropriate type.
Erroneously reporting codes (e.g., missing fifth digit)

Accepted Answer

Erroneously reporting codes, such as a missing fifth digit, is an example of abuse rather than fraud. Abuse refers to practices where healthcare providers or patients misuse healthcare resources, whereas fraud involves intentional deception for personal gain.

Question 17

The False Claims Act was originally used during the Civil War to prosecute those who provided the Union with inferior products or cheated the government.Today, it is used to prosecute healthcare providers who _____.

Accepted Answer

The False Claims Act is used to prosecute healthcare providers who charge for healthcare services not rendered or provide inferior products or services to the government. Refusing to accept remuneration for referrals, suing the government for fraud and abuse, or using USPS or commercial wire services to commit fraud do not fall under the purview of the False Claims Act.

Question 18

Match the type of facility or service with the appropriate law.
Home health agencies

Accepted Answer

Home health agencies are subject to Stark II laws, which prohibit physicians from making referrals to entities in which they have a financial interest for designated health services.

Question 19

Addressing health care fraud and abuse is of increasing importance to federal and state governments as they seek additional _____ to overhaul health care in the United States.

Accepted Answer

The sentence indicates that federal and state governments need additional funding in order to overhaul health care in the United States, and addressing health care fraud and abuse is one way to potentially save money and redirect it towards overall health care reform efforts.

Question 20

Match the examples of fraud and abuse with the appropriate type.
Billing for services not medically necessary

Accepted Answer

Billing for services not medically necessary is considered fraud because it involves intentionally and knowingly submitting false claims for payment. It is an intentional act of deception to receive payment for services that were not actually provided or necessary. Abuse, on the other hand, refers to actions that are inconsistent with accepted business or medical practices but may not necessarily involve intentional deception.

Quiz 14: Health-Care Fraud and Abuse: Part A

Match the examples of fraud and abuse with the appropriate type. Mistakenly sequencing codes out of order

Which allows private plaintiffs to sue on behalf of the U.S government and, as a result, receive a portion of the recovered funds if the case is successful?

Federal anti-kickback statutes prohibit providers from receiving or offering money in exchange for patient Medicare and Medicaid referrals to another provider of medical services.Most state antikickback statutes also include _____, which means they can be charged with a crime under the statutes.

HIPAA modified the _____ to create penalties for unbundling, upcoding, billing for medically unnecessary services, and so on.

Match the type of facility or service with the appropriate law. Occupational and physical therapy practices

Efforts to establish a culture that promotes prevention, detection, and resolution of instances of conduct that do not conform to application local, state, and federal laws is called _____.

Match the type of facility or service with the appropriate law. Stand-alone radiology facilities

Match the examples of fraud and abuse with the appropriate type. Upcoding and unbundling codes

Match the examples of fraud and abuse with the appropriate type. Charging for procedures that were not performed

Which is the penalty for felony violation of mail and wire fraud statutes?

Federal and state government health programs and third-party payers lose _____ of dollars annually due to intentional fraudulent actions and poor coding practices.

Corporate integrity agreements that are part of a financial settlement agreement with the federal government in a fraud and abuse case are _____.

Which software technology is most commonly associated with combating fraud and abuse?

Match the type of facility or service with the appropriate law. Durable medical equipment companies

Match the type of facility or service with the appropriate law. Clinical laboratories

Match the examples of fraud and abuse with the appropriate type. Erroneously reporting codes (e.g., missing fifth digit)

The False Claims Act was originally used during the Civil War to prosecute those who provided the Union with inferior products or cheated the government.Today, it is used to prosecute healthcare providers who _____.

Match the type of facility or service with the appropriate law. Home health agencies

Addressing health care fraud and abuse is of increasing importance to federal and state governments as they seek additional _____ to overhaul health care in the United States.

Match the examples of fraud and abuse with the appropriate type. Billing for services not medically necessary