AAPC
Certified Professional Medical Auditor (CPMA)®
AAPC Certification Exam
AAPC CPMA Certification Core + Medical Auditing
AAPC CPMA Certification Exam
Course Title and Number: AAPC CPMA Certification Exams
Exam Title: Midterm, Finals, Certification and Assessment
Exam Date: Exam 2025- 2026
Instructor: ____ [Insert Instructor’s Name] _______
Student Name: ___ [Insert Student’s Name] _____
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Examination
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Instructions:
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CPMA Certified Professional Medical Auditor AAPC Certification
Exam Review AAPC (CPMA)® Exam Questions and Answers |
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2025- 2026
AAPC CPMA Certification Exam
Certified Professional Medical Auditor (CPMA)®
AAPC CPMA Certification Core + Medical Auditing
AAPC Certification Exam
American Academy of Professional Coders AAPC.
Read All Instructions Carefully and Answer All the
Questions Correctly Good Luck: -
CPMA Certification Exam
Certified Professional Medical Auditor
(CPMA)®
AAPC CPMA Certification Core + Medical
Auditing
AAPC Certification Exam
American Academy of Professional Coders
AAPC.
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CMS Fraud Definition - =Answer>> Making false statements
or misrepresenting facts to obtain an undeserved benefit or
payment from a federal healthcare program
CMS Abuse Definition - =Answer>> An action that results in
unnecessary costs to a federal healthcare program, either
directly or indirectly
CMS Examples of Fraud - =Answer>> Billing for services
and/or supplies that you know were not furnished or provided,
altering claim forms and/or receipts to receive a higher
payment amount, billing a Medicare patient above the allowed
amount for services, billing for services at a higher level than
provided or necessary, misrepresenting the diagnosis to justify
payment
CMS Examples of Abuse - =Answer>> Misusing codes on a
claim, charging excessively for services or supplies, billing for
services that were not medically necessary, failure to maintain
adequate medical or financial records, improper billing
practices, billing Medicare patients a higher fee schedule than
non-Medicare patients
False Claims Act - =Answer>> Any person is liable if they
knowingly present or cause to be presented a false or
fraudulent claim for payment or approval; knowingly makes,
uses, or causes to be made or used, a false record or material
to a false or fraudulent claims
Current False Claims Act penalties - =Answer>> $5,500-
$11,000 per claim
When does the False Claims Act allow for reduced penalties? -
=Answer>> If the person committing the violation self-
discloses and provides all known info within 30 days, fully
cooperates with the investigation, and there is no criminal
prosecution, civil action, or administrative action regarding the
violation
Qui Tam or "Whistleblower" provision - =Answer>> If an
individual (known as a "relator") knows of a violation of the
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False Claims Act, he or she may bring a civil action on behalf of
him or herself and on behalf of the U.S. government; the relator
may be awarded 15-25% of the dollar amount recovered
Stark or Physician Self-Referral Law - =Answer>> Bans
physicians from referring patients for certain services to
entities in which the physician or an immediate family member
has a direct or indirect financial relationship; bans the entity
from billing Medicare or Medicaid for the services provided as a
result of the self-referral
Anti-Kickback Law - =Answer>> Similar to the Stark Law but
imposes more severe penalties; states that whoever knowingly
or willfully solicits or receives any remuneration in return for
referring an individual to a person for the furnishing or
arranging of any item or service for which payment may be
made in whole or in part under a federal healthcare program or
in return for purchasing, leasing, ordering, or arranging for or
recommending purchasing, leasing, or ordering any good,
facility, service, or item for which payment may be made in
whole or in part under a federal healthcare program is guilty of
a felony
Penalty for violating the Anti-Kickback Law - =Answer>> Up
to $25,000 fine and/or imprisonment of up to 5 years
Stark Law vs. Anti-Kickback Law - =Answer>> Anti-Kickback
applies to anyone, not just physicians; the Anti-Kickback Law
requires proof of intention and states that the person must
"knowingly and willfully" violate the law.
Exclusion Statute - =Answer>> Under the Exclusion Statute,
a physician who is convicted of a criminal offense—such as
Medicare fraud (both misdemeanor and felony convictions),
patient abuse and neglect, or illegal distribution of controlled
substances—can be banned from participating in Medicare by
the OIG. Physicians who are excluded may not directly or
indirectly bill the federal government for the services they
provide to Medicare patients.
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