Chapter 11 - RACs, ZPICs, MICs, PSCs,
MFCUs Exam 2025 Questions and
Answers
What sets ZPIC audits apart from other Medicare audits? - ....ANSWER ...-They
Perform Nationwide Audits targeted by potential Medicare Fraud
Audit MICs can audit a Medicaid provider throughout his or her__________. -
....ANSWER ...-Country
How many regions are part of the Medicaid Fraud Control Unit? - ....ANSWER ...-
6
What is the level 3 of the RAC Claims appeals process? - ....ANSWER ...-Hearing
by an Admin Law Judge (ALJ)
What type of software process identifies potential claim errors? - ....ANSWER ...-
Data Mining
RACs perform what type of review(s) - ....ANSWER ...-Automated & Complex
What description below best describes ZPICs? - ....ANSWER ...-*They're
PRIVATE COMPANIES.
*They DO NOT WORK ON CONTINGENCY FEES; therefore,
*they are PAID DIRECTLY by CMS.
…FOR STUDENTS ONLY…©️2025 ALL RIGHTS RESERVED… 1
,*The primary goal of the ZPIC is to IDENTIFY CASES of suspected fraud, DEVELOP
THEM thoroughly, and TAKE immediate ACTION.
What does Medicare Part D cover? - ....ANSWER ...-prescription drugs
Medicaid Fraud Control Units (MFCUs) operate under the direction of _______. -
....ANSWER ...-OIG
Comprehensive Error Rate Testing Program (CERT) started in what year? -
....ANSWER ...-2001
Which of the following is TRUE per CMS website? - ....ANSWER ...-If your
practice or health care organization bills fee-for-service programs, your claims will be
subject to review by the RACs.
RACs can look back how many years from a date of service? - ....ANSWER ...-3 yrs
Which one of the following monitors the MACs? - ....ANSWER ...-CERT
asks the Compliance Officer if the Medicaid Integrity Contractor (MIC) has authority to
audit claims in a particular region or in any state? The Compliance Officer states that
_________ - ....ANSWER ...-THEY work in ANY state
What department oversees the ZPICs and MEDIC? - ....ANSWER ...-Center for
Program integrity (CPI)
UNDER CMS
Which of the following is TRUE regarding Audit MIC? - ....ANSWER ...-Audit
MIC can audit ANY provider
…FOR STUDENTS ONLY…©️2025 ALL RIGHTS RESERVED… 2
, The Yates Memo of 2015 considers what factors? - ....ANSWER ...-Corporate
Wrongdoing
What do ZPICs Not Do? - ....ANSWER ...-proactively IDENTIFY INCIDENTS
of potential fraud that exist within its service area, nor do they take appropriate action on
each case.
Can providers request an extension to provide records requested by an auditor if there is
a problem meeting the deadline? - ....ANSWER ...-Yes, by calling the requestor
and explaining the reason for the delay
What does MIP stand for? - ....ANSWER ...-Medicaid Integrity Program
Corrective actions that result from an Audit? - ....ANSWER ...-*conducting
provider education efforts, but not for their clinical staff.
*Improving System edits,
* Updating policies and manuals, and
*refining improper payment rate measurements
Who cannot be considered a violator of fraud? - ....ANSWER ...-Anyone Can Be
Considered a Violator Of Fraud..
The ______________ was signed into law and requires CMS to use competitive
procedures to replace its current fraud inspections and carriers with a uniform type of
administrative entity, referred to as Medicare administrative contractors (MAC). -
....ANSWER ...-MMA
The main task of ____________________________ are to perform and/or provide
support for a variety of tasks aimed at lowering the improper payment rates and
…FOR STUDENTS ONLY…©️2025 ALL RIGHTS RESERVED… 3
MFCUs Exam 2025 Questions and
Answers
What sets ZPIC audits apart from other Medicare audits? - ....ANSWER ...-They
Perform Nationwide Audits targeted by potential Medicare Fraud
Audit MICs can audit a Medicaid provider throughout his or her__________. -
....ANSWER ...-Country
How many regions are part of the Medicaid Fraud Control Unit? - ....ANSWER ...-
6
What is the level 3 of the RAC Claims appeals process? - ....ANSWER ...-Hearing
by an Admin Law Judge (ALJ)
What type of software process identifies potential claim errors? - ....ANSWER ...-
Data Mining
RACs perform what type of review(s) - ....ANSWER ...-Automated & Complex
What description below best describes ZPICs? - ....ANSWER ...-*They're
PRIVATE COMPANIES.
*They DO NOT WORK ON CONTINGENCY FEES; therefore,
*they are PAID DIRECTLY by CMS.
…FOR STUDENTS ONLY…©️2025 ALL RIGHTS RESERVED… 1
,*The primary goal of the ZPIC is to IDENTIFY CASES of suspected fraud, DEVELOP
THEM thoroughly, and TAKE immediate ACTION.
What does Medicare Part D cover? - ....ANSWER ...-prescription drugs
Medicaid Fraud Control Units (MFCUs) operate under the direction of _______. -
....ANSWER ...-OIG
Comprehensive Error Rate Testing Program (CERT) started in what year? -
....ANSWER ...-2001
Which of the following is TRUE per CMS website? - ....ANSWER ...-If your
practice or health care organization bills fee-for-service programs, your claims will be
subject to review by the RACs.
RACs can look back how many years from a date of service? - ....ANSWER ...-3 yrs
Which one of the following monitors the MACs? - ....ANSWER ...-CERT
asks the Compliance Officer if the Medicaid Integrity Contractor (MIC) has authority to
audit claims in a particular region or in any state? The Compliance Officer states that
_________ - ....ANSWER ...-THEY work in ANY state
What department oversees the ZPICs and MEDIC? - ....ANSWER ...-Center for
Program integrity (CPI)
UNDER CMS
Which of the following is TRUE regarding Audit MIC? - ....ANSWER ...-Audit
MIC can audit ANY provider
…FOR STUDENTS ONLY…©️2025 ALL RIGHTS RESERVED… 2
, The Yates Memo of 2015 considers what factors? - ....ANSWER ...-Corporate
Wrongdoing
What do ZPICs Not Do? - ....ANSWER ...-proactively IDENTIFY INCIDENTS
of potential fraud that exist within its service area, nor do they take appropriate action on
each case.
Can providers request an extension to provide records requested by an auditor if there is
a problem meeting the deadline? - ....ANSWER ...-Yes, by calling the requestor
and explaining the reason for the delay
What does MIP stand for? - ....ANSWER ...-Medicaid Integrity Program
Corrective actions that result from an Audit? - ....ANSWER ...-*conducting
provider education efforts, but not for their clinical staff.
*Improving System edits,
* Updating policies and manuals, and
*refining improper payment rate measurements
Who cannot be considered a violator of fraud? - ....ANSWER ...-Anyone Can Be
Considered a Violator Of Fraud..
The ______________ was signed into law and requires CMS to use competitive
procedures to replace its current fraud inspections and carriers with a uniform type of
administrative entity, referred to as Medicare administrative contractors (MAC). -
....ANSWER ...-MMA
The main task of ____________________________ are to perform and/or provide
support for a variety of tasks aimed at lowering the improper payment rates and
…FOR STUDENTS ONLY…©️2025 ALL RIGHTS RESERVED… 3
