©BRIGHTSTARS EXAM SOLUTIONS
10/21/2024 9:24 PM
Certified Professional Biller CPB Exam
Questions And Answers 100% Pass.
Fraud - answer✔Knowingly and willfully executing, or attempting to execute, a scheme or
artifice to defraud any health care benefit program or to obtain, by means of false or fraudulent
pretenses, representations, or promises, any of the money or property owned by, or under the
custody or control of, any health care benefit program.
Waste - answer✔Includes practices that, directly or indirectly, result in unnecessary costs to the
Medicare Program, such as overusing services. Generally not considered to be caused by
criminally negligent actions but rather by the misuse of resources.
Abuse - answer✔Includes actions that may, directly or indirectly, result in unnecessary costs to
the Medicare Program. Involves paying for items or services when there is no legal entitlement
to that payment, and the provider has not knowingly or intentionally misrepresented facts to
obtain payment.
Examples of Fraud - answer✔Knowingly billing for services not furnished or supplies not
provided, including billing Medicare for appointments the patient failed to keep
Billing for nonexistent prescriptions
Knowingly altering claim forms, medical records, or receipts to receive a higher payment
Examples of Waste - answer✔Conducting excessive office visits or writing excessive
prescriptions
Prescribing more medications than necessary for treating a specific condition
Ordering excessive laboratory tests
Examples of Abuse - answer✔Unknowingly billing for unnecessary medical services
Unknowingly billing for brand name drugs when generics are dispensed
Unknowingly excessively charging for services or supplies
Unknowingly misusing codes on a claim, such as upcoding or unbundling codes
10/21/2024 9:24 PM
Certified Professional Biller CPB Exam
Questions And Answers 100% Pass.
Fraud - answer✔Knowingly and willfully executing, or attempting to execute, a scheme or
artifice to defraud any health care benefit program or to obtain, by means of false or fraudulent
pretenses, representations, or promises, any of the money or property owned by, or under the
custody or control of, any health care benefit program.
Waste - answer✔Includes practices that, directly or indirectly, result in unnecessary costs to the
Medicare Program, such as overusing services. Generally not considered to be caused by
criminally negligent actions but rather by the misuse of resources.
Abuse - answer✔Includes actions that may, directly or indirectly, result in unnecessary costs to
the Medicare Program. Involves paying for items or services when there is no legal entitlement
to that payment, and the provider has not knowingly or intentionally misrepresented facts to
obtain payment.
Examples of Fraud - answer✔Knowingly billing for services not furnished or supplies not
provided, including billing Medicare for appointments the patient failed to keep
Billing for nonexistent prescriptions
Knowingly altering claim forms, medical records, or receipts to receive a higher payment
Examples of Waste - answer✔Conducting excessive office visits or writing excessive
prescriptions
Prescribing more medications than necessary for treating a specific condition
Ordering excessive laboratory tests
Examples of Abuse - answer✔Unknowingly billing for unnecessary medical services
Unknowingly billing for brand name drugs when generics are dispensed
Unknowingly excessively charging for services or supplies
Unknowingly misusing codes on a claim, such as upcoding or unbundling codes
