ATI Healthcare Fraud, Waste, and Abuse Prevention Post Test Questions and Answers | Latest Version | 2025/2026 | Correct & Verified

ATI Healthcare Fraud, Waste, and Abuse Prevention Post Test Questions and Answers | Latest Version | 2025/2026 | Correct & Verified How can a healthcare provider prevent unintentional fraud in billing? By ensuring accurate documentation, verifying services provided, and following up on any discrepancies in coding or billing. What is an example of healthcare waste? Ordering unnecessary diagnostic tests or procedures that do not improve patient outcomes is an example of healthcare waste. What is the significance of compliance programs in healthcare organizations? Compliance programs help ensure that healthcare organizations operate within legal and ethical guidelines, reducing the risk of fraud and abuse. What should a nurse do if they suspect a colleague is committing healthcare fraud? The nurse should report the suspicion to the appropriate authorities within the organization, such as a compliance officer or supervisor. 2 What is the difference between fraud and abuse in healthcare? Fraud involves intentionally deceptive practices for personal gain, while abuse refers to practices that are improper but not necessarily intentional. Why is upcoding considered a form of healthcare fraud? Upcoding occurs when a healthcare provider submits claims for services that were not provided or for a higher level of service than was actually performed, resulting in fraudulent overpayment. How can healthcare organizations train employees to prevent fraud? By providing regular education on fraud, waste, and abuse prevention, including ethical practices, proper documentation, and the importance of compliance with regulations. What is the role of the Office of Inspector General (OIG) in healthcare fraud prevention? The OIG investigates and prosecutes cases of fraud and abuse in healthcare, while also providing resources and guidance to healthcare organizations to ensure compliance. What are kickbacks in healthcare, and why are they considered fraud? 3 Kickbacks are illegal payments or incentives given to healthcare providers in exchange for patient referrals or services, and they constitute fraud because they compromise patient care and create conflicts of interest. What is one way to prevent healthcare fraud in medical billing? Healthcare providers should implement robust internal audits, verify coding accuracy, and train staff on correct billing practices. How does waste in healthcare contribute to higher costs for patients? Waste, such as overutilization of services, unnecessary tests, and redundant procedures, leads to unnecessary costs that ultimately raise the financial burden on patients and insurance companies. Why is it important for healthcare employees to understand the False Claims Act? Understanding the False Claims Act is crucial because it imposes penalties for submitting false or fraudulent claims to the government, and healthcare employees are often key in preventing such claims. What is an example of abuse in healthcare?