The Answer of Match the following:

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Match the Following

Question 81

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Match the following:

Premises:

Responses:

Physician does NOT provide a sufficient level of treatment because of a fixed capitation payment arrangement

fraud indicator

Law that provides workers' compensation benefits to employees of the United States government

Social Security Disability Insurance

Physician orders unnecessary treatments or tests to enable billing for higher fees

Federal Employees' Compensation Act

Illegal incentives paid for patient referrals

upcoding

Providers collude with the insurance company to defraud the employer

kickbacks

Billing by a provider for a more expensive service than the one performed

underutilization

A sign that suggests that some type of illegal behavior may be occurring; triggers a closer review of a claim or situation

Occupational Safety and Health Act

Physician performs a single service but bills it as a series of separate procedures

internal fraud

Government program that provides income benefits to people who cannot work because of a medical condition lasting 1 year or more

overutilization

Law that provides the government with the authority to set and enforce safety and health standards for employers

unbundling

Premises:

Physician does NOT provide a sufficient level of treatment because of a fixed capitation payment arrangement

Law that provides workers' compensation benefits to employees of the United States government

Physician orders unnecessary treatments or tests to enable billing for higher fees

Illegal incentives paid for patient referrals

Providers collude with the insurance company to defraud the employer

Billing by a provider for a more expensive service than the one performed

A sign that suggests that some type of illegal behavior may be occurring; triggers a closer review of a claim or situation

Physician performs a single service but bills it as a series of separate procedures

Government program that provides income benefits to people who cannot work because of a medical condition lasting 1 year or more

Law that provides the government with the authority to set and enforce safety and health standards for employers

Responses:

fraud indicator

Social Security Disability Insurance

Federal Employees' Compensation Act

upcoding

kickbacks

underutilization

Occupational Safety and Health Act

internal fraud

overutilization

unbundling

Correct Answer:

Premises:

Responses:

Physician does NOT provide a sufficient level of treatment because of a fixed capitation payment arrangement

Law that provides workers' compensation benefits to employees of the United States government

Physician orders unnecessary treatments or tests to enable billing for higher fees

Illegal incentives paid for patient referrals

Providers collude with the insurance company to defraud the employer

Billing by a provider for a more expensive service than the one performed

A sign that suggests that some type of illegal behavior may be occurring; triggers a closer review of a claim or situation

Physician performs a single service but bills it as a series of separate procedures

Government program that provides income benefits to people who cannot work because of a medical condition lasting 1 year or more

Law that provides the government with the authority to set and enforce safety and health standards for employers