CPMA Exam Questions and Answers
(100% Pass)
CMS Fraud Definition
Making false statements or misrepresenting facts to obtain an undeserved
benefit or payment from a federal healthcare program
CMS Abuse Definition
An action that results in unnecessary costs to a federal healthcare program,
either directly or indirectly
CMS Examples of Fraud
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
,Master01 | October, 2025/2026| Latest update
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
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
$10,957-$21,916 per claim plus three times the amount of damages
When does the False Claims Act allow for reduced penalties?
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
Master01 | October, 2025/2026| Latest update
If an individual (known as a "relator") knows of a violation of the 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
Bans fphysicians ffrom freferring fpatients ffor fcertain fservices fto fentities fin
fwhich fthe fphysician for fan fimmediate ffamily fmember fhas fa fdirect for findirect
ffinancial frelationship; fbans fthe fentity ffrom fbilling fMedicare for fMedicaid ffor fthe
fservices fprovided fas fa fresult fof fthe fself-referral
Anti-Kickback fLaw
Similar fto fthe fStark fLaw fbut fimposes fmore fsevere fpenalties; fstates fthat
fwhoever fknowingly for fwillfully fsolicits for freceives fany fremuneration fin
, return ffor freferring fan findividual fto fa fperson ffor fthe ffurnishing for farranging fof
fany fitem for fservice ffor fwhich fpayment fmay fbe fmade fin fwhole for fin fpart funder fa
ffederal fhealthcare fprogram for fin freturn ffor fpurchasing, fleasing, fordering, for
farranging ffor for frecommending
purchasing, fleasing, for fordering fany fgood, ffacility, fservice, for fitem ffor fwhich
fpayment fmay fbe fmade fin fwhole for fin fpart funder fa ffederal fhealthcare fprogram fis
fguilty fof fa ffelony
Master01 f| fOctober, f2025/2026| fLatest fupdate
f
Penalty ffor fviolating fthe fAnti-Kickback fLaw
Up fto f$25,000 ffine fand/or fimprisonment fof fup fto f5 fyears
Stark fLaw fvs. fAnti-Kickback fLaw
Anti-Kickback fapplies fto fanyone, fnot fjust fphysicians; fthe fAnti-Kickback
fLaw frequires fproof fof fintention fand fstates fthat fthe fperson fmust
"knowingly fand fwillfully" fviolate fthe flaw.
Penalties ffor fthe fStark fLaw
(100% Pass)
CMS Fraud Definition
Making false statements or misrepresenting facts to obtain an undeserved
benefit or payment from a federal healthcare program
CMS Abuse Definition
An action that results in unnecessary costs to a federal healthcare program,
either directly or indirectly
CMS Examples of Fraud
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
,Master01 | October, 2025/2026| Latest update
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
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
$10,957-$21,916 per claim plus three times the amount of damages
When does the False Claims Act allow for reduced penalties?
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
Master01 | October, 2025/2026| Latest update
If an individual (known as a "relator") knows of a violation of the 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
Bans fphysicians ffrom freferring fpatients ffor fcertain fservices fto fentities fin
fwhich fthe fphysician for fan fimmediate ffamily fmember fhas fa fdirect for findirect
ffinancial frelationship; fbans fthe fentity ffrom fbilling fMedicare for fMedicaid ffor fthe
fservices fprovided fas fa fresult fof fthe fself-referral
Anti-Kickback fLaw
Similar fto fthe fStark fLaw fbut fimposes fmore fsevere fpenalties; fstates fthat
fwhoever fknowingly for fwillfully fsolicits for freceives fany fremuneration fin
, return ffor freferring fan findividual fto fa fperson ffor fthe ffurnishing for farranging fof
fany fitem for fservice ffor fwhich fpayment fmay fbe fmade fin fwhole for fin fpart funder fa
ffederal fhealthcare fprogram for fin freturn ffor fpurchasing, fleasing, fordering, for
farranging ffor for frecommending
purchasing, fleasing, for fordering fany fgood, ffacility, fservice, for fitem ffor fwhich
fpayment fmay fbe fmade fin fwhole for fin fpart funder fa ffederal fhealthcare fprogram fis
fguilty fof fa ffelony
Master01 f| fOctober, f2025/2026| fLatest fupdate
f
Penalty ffor fviolating fthe fAnti-Kickback fLaw
Up fto f$25,000 ffine fand/or fimprisonment fof fup fto f5 fyears
Stark fLaw fvs. fAnti-Kickback fLaw
Anti-Kickback fapplies fto fanyone, fnot fjust fphysicians; fthe fAnti-Kickback
fLaw frequires fproof fof fintention fand fstates fthat fthe fperson fmust
"knowingly fand fwillfully" fviolate fthe flaw.
Penalties ffor fthe fStark fLaw
