Fraud, Waste, and Abuse in Healthcare questions with correct answers

What is healthcare fraud? CORRECT ANSWER - Illegal acts that are performed for financial gain - Knowingly and willingly committing these acts - Occur when an insurer is billed for services or medical devices that didn't occur or weren't needed. Who can be stakeholders in committing healthcare fraud? CORRECT ANSWER - Crime rings improperly billing medicare - Physicians charging for and performing a more complex procedure than is necessary - Healthcare systems defrauding Medicare and Medicaid - Individuals sharing their healthcare info with another person What are some examples of Medicare fraud? CORRECT ANSWER - Knowingly billing for services not furnished or supplies not provided - Billing for nonexistent prescriptions - Altering claim forms, medical records, or receipts to receive higher payment What is the False Claims Act? CORRECT ANSWER - Amended in 1990 to focus on healthcare fraud - Amended in 1995 to add criminal penalties What are the three elements of the False Claims Act that the government must prove? CORRECT ANSWER - Defendant executed a scheme to defraud any healthcare benefit program