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

Question 1

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

A)Abuse
B)Fraud

Answer 1

Abuse

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?

A)qui tam actions
B)res gestae
C)respondeat superior
D)subpoena duces tecum

Answer 2

qui tam actions

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.

A)attorneys, including local district attorneys
B)healthcare facilities and their providers
C)managed care and private insurance companies
D)patients and their healthcare representatives

Answer 3

managed care and private insurance companies

Question 4

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

A)civil money penalty law
B)false claims act
C)qui tam actions law
D)red flag rule

Question 5

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

A)Stark I
B)Stark II

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 _____.

A)compliance
B)fraud
C)quit tam
D)regulation

Question 7

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

A)Stark I
B)Stark II

Question 8

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

A)Abuse
B)Fraud

Question 9

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

A)Abuse
B)Fraud

Question 10

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

A)$1,000 fine and/or 5-year prison term
B)$5,000 fine and/or 1-year prison term
C)$10,000 fine and/or 5-year prison term
D)$50,000 fine and/or 10-year prison term

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.

A)billions
B)millions
C)thousands
D)trillions

Question 12

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

A)issued by the Federal Trade Commission
B)most commonly negotiated for monetary gain
C)used to settle Federal government litigation
D)written to specify rules of conduct

Question 13

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

A)automated coding software
B)electronic health record
C)programming languages
D)statistical analysis software

Question 14

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

A)Stark I
B)Stark II

Question 15

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

A)Stark I
B)Stark II

Question 16

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

A)Abuse
B)Fraud

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 _____.

A)charge for healthcare services not rendered
B)refuse to accept remuneration for referrals
C)sue the government for fraud and abuse
D)use the USPS or commercial wire services to commit fraud

Question 18

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

A)Stark I
B)Stark II

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.

A)documentation
B)funding
C)staffing
D)technology

Question 20

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

A)Abuse
B)Fraud

Question 21

Match the description with the appropriate Federal legislation.
Clarifies who can be held accountable for wrongful disclosure of protected information, which means an individual who discloses the information, as well as the health care organization or entity, may be prosecuted.

A)American Recovery and Reinvestment Act
B)Deficit Reduction Act
C)False Claims Act
D)Health Insurance Portability and Accountability Act
E)Stark I and Stark II

Question 22

Match the description with the appropriate Federal legislation.
Provided added strength to combat fraud and abuse in the Medicaid program and changed some compliance programs from voluntary to mandatory.

A)American Recovery and Reinvestment Act
B)Deficit Reduction Act
C)False Claims Act
D)Health Insurance Portability and Accountability Act
E)Stark I and Stark II

Question 23

Match the description with the appropriate Federal legislation.
Includes the Beneficiary Incentive Program, Health Care Fraud and Abuse Data Collection Program, and the Medicare Integrity Program.

A)American Recovery and Reinvestment Act
B)Deficit Reduction Act
C)False Claims Act
D)Health Insurance Portability and Accountability Act
E)Stark I and Stark II

Question 24

Match the law enforcement agency that fights fraud and abuse with its purpose.
Authorized to bring civil actions related to healthcare fraud and abuse (within its own jurisdiction).

A)Federal Bureau of Investigation
B)Office of Inspector General
C)State Attorney General

Question 25

Match the description with the appropriate Federal legislation.
Bars physician self-referral of Medicare or Medicaid patients to another health care facility/service in which the physician or a family member has a financial interest.

A)American Recovery and Reinvestment Act
B)Deficit Reduction Act
C)False Claims Act
D)Health Insurance Portability and Accountability Act
E)Stark I and Stark II

Question 26

Match the law enforcement agency that fights fraud and abuse with its purpose.
Its DCIS branch investigates fraud schemes committed against the military's health insurance.

A)Federal Bureau of Investigation
B)Office of Inspector General
C)State Attorney General

Question 27

Match the law enforcement agency that fights fraud and abuse with its purpose.
Provides guidance to healthcare providers about complying with local, state, and federal laws and regulations.

A)Federal Bureau of Investigation
B)Office of Inspector General
C)State Attorney General

Question 28

Match the law enforcement agency that fights fraud and abuse with its purpose.
Agency that is authorized to conduct civil, administrative, and criminal investigations for Medicare and Medicaid.

A)Federal Bureau of Investigation
B)Office of Inspector General
C)State Attorney General

Question 29

Match the description with the appropriate Federal legislation.
Used to prosecute healthcare providers who knowingly submit false claims to receive reimbursement for services that were never rendered to patients.

A)American Recovery and Reinvestment Act
B)Deficit Reduction Act
C)False Claims Act
D)Health Insurance Portability and Accountability Act
E)Stark I and Stark II

Question 30

Match the law enforcement agency that fights fraud and abuse with its purpose
Federal agency whose authority extends beyond the jurisdiction of government programs.

A)Federal Bureau of Investigation
B)Office of Inspector General
C)State Attorney General