Deck 11: Health-care Fraud and Abuse

Question 1

Fraud can range from an individual or single practitioner to a(n):

A) group of individuals.
B) institution.
C) corporate entity.
D) All of these are correct.
E) None of these is correct.

Answer 1

D

Question 2

Over the past few years, the Centers for Medicare and Medicaid Services (CMS) has implemented some powerful tools that shift the focus from a ______________ approach to a prospective approach that looks to prevent fraud.

A) prospective
B) retrospective
C) "pay and chase"
D) None of these is correct.

Answer 2

C

Question 3

The success of a program like this one is realized in dollars, in that for every $1 spent, there is a savings of _______________ in the first year of this program.

A) $2
B) $3
C) $4
D) $1
E) None of these is correct.

Answer 3

B

Question 4

CMS has also started a campaign called "Help Prevent Fraud," which educates people on protecting themselves against fraud. This education process includes:

A) telling people never to give out their social security number to anyone.
B) reporting any suspicious activity.
C) that Medicare will be the only one to call for this information.
D) both telling people never to give out their social security number to anyone and reporting any suspicious activity.
E) None of these is correct.

Question 5

The Health Care Fraud Prevention and Enforcement Action Team (HEAT) is a joint initiative between:

A) DHS and CMS.
B) DHS and OIG.
C) DHS and DOJ.
D) CMS and DOJ.

Question 6

The mission of the HEAT Team is to gather resources across government agencies to help prevent waste, fraud, and abuse in the Medicare and Medicaid programs, which will:

A) reduce skyrocketing healthcare costs.
B) improve the quality of care.
C) highlight best practices.
D) All of these are correct.
E) both improve the quality of care and highlight best practices.

Question 7

When a provider is excluded from all Federal Healthcare Programs, there cannot be:

A) any payment made for any items or services furnished by an excluded person.
B) services provided at the direction of or on the prescription of an excluded person.
C) All of these are correct.
D) None of these is correct.

Question 8

Which of the following is included in the LEIE online database?

A) Name of the excluded person
B) Provider type
C) Authority that excluded the person
D) All of these are correct.
E) None of these is correct.

Question 9

The CMS Self-Referral Disclosure Protocol (SRDP) enables providers of services and suppliers to ______________ actual or potential violations of the physician self-referral statute.

A) report internally
B) self-disclose
C) fix the issue and not report the
D) None of these is correct.

Question 10

Medicare defines fraud as an occurrence where someone intentionally falsifies information or deceives Medicare.

Question 11

Medicare abuse is when a supplier or practitioner either directly or indirectly has practices that result in unnecessary costs to the Medicare Program.

Question 12

The National Benefit Integrity Medicare Drug Integrity Contractor (NBI MEDIC) program supports the CMS Center for Program Integrity and monitors fraud and abuse in Medicare Part C and Part D programs in all 50 states, the District of Columbia, and U.S. territories.

Question 13

The False Claims Act (FCA) of the United States Code Sections 3729-3733 protects the government from being overcharged or sold substandard goods or services.

Question 14

The Criminal Health Care Fraud Statute is found in 18 U.S. Code Section 1347 and prohibits knowingly and willfully executing or attempting to execute a scheme to defraud only a Medicare program.

Question 15

An excluded provider is unable to treat a patient, but may refer a patient to a non-excluded provider if the excluded provider does not furnish, order, or prescribe any services for the referred patient.

Question 16

If an excluded person violates the imposed exclusion, furnishes items or services to a Federal Healthcare Program beneficiary, and submits a claim for payment of these services, the excluded person may be subject to CMP of $10,000 for all claimed items or services furnished during the period that the person was excluded.

Question 17

After the internal audits are completed and if they have identified any risk areas, the next step is to develop a method for dealing with those risk areas through practice standards and procedures. Written standards and procedures are not always a vital component of any compliance program.

Question 18

The OIG understands that the physician practice should be able to order tests, including screening tests that they believe are appropriate for treating their patients. With that said, Medicare will only pay for services that meet the Medicare definition of reasonable and necessary.