compliance, fraud, abuse and waste questions with correct answers

what are your responsibilities(3) CORRECT ANSWER prevent, detect and report medicare non-compliance as well as possible fraud, waste and abuse 1. comply with all requirements 2. report 3. follow organizations code of conduct how do you prevent fraud CORRECT ANSWER be up to date on laws coordinate with other payers correct/timely data/billing verify information be on lookout for suspicious activity CRIMINAL FRAUD CORRECT ANSWER KNOWING and WILLFULLY (intent) execute scheme or defraud any health benefit program to obtain money or property intentionally submitting false information to gov in order to get money or benefit WASTE CORRECT ANSWER over utilization of services or practices that in/directly result in unnecessary costs - generally not considered criminally negligent (rather misuse) ABUSE CORRECT ANSWER actions in/directly result in costs - involves payment for items or services when there is not legal entitlement - intentional misrepresentation