FRAUD, WASTE, AND ABUSE, FWA, Top Exam Questions and answers, 100% Accurate. Verified.

FRAUD, WASTE, AND ABUSE, FWA, Top Exam Questions and answers, 100% Accurate. Verified. The AF policy on FWA is to use all available means to: - -- prevent, detect, & correct instances of FWA - appropriately discipline perpetrators involved in FWA activities - recoup losses of cash, property, & services resulting from FWA if possible Fraud - -any intentional deception designed to unlawfully deprive the gov't of something of value or to secure from the gov't for an individual benefit, privilege, allowance, or consideration to which he or she is not entitled Waste - -the extravagant, careless, or needless expenditure of gov't funds or the consumption of gov't property that results from deficient practices, systems controls, or decisions Abuse - -intentional wrongful or improper use of gov't resources Abuse of Authority - -an arbitrary and capricious exercise of power by a military member or a federal official or employee ACA Section 1557, and the Final Rule interpreting it as drafted by the Obama Administration, differs from earlier legislation in providing broader protection against discrimination based on - -sex. Under ACA Section 1557, a health plan sold through a state exchange may, based on an individual's age - -charge higher premiums ACA Section 1557 rules for disability concern - -Policies and procedures, physical access, and communication As a result of violations of ACA Section 1557 nondiscrimination rules, - -a health plan may revoke an agent or broker's appointment with the health plan Which Medicare programs are covered by ACA Section 1557? - -Parts A, C, and D, but not B You are in charge of paying claims submitted by providers. You notice a certain diagnostic provider ("Doe Diagnostics") requested a substantial payment for a large number of members. Many of these claims are for a certain procedure. You review the same type of procedure for other diagnostic providers and realize Doe Diagnostics' claims far exceed any other provider you reviewed. What should you do? - -Consult with your immediate supervisor for next steps or contact the compliance department (via compliance hotline, Special Investigations Unit [SIU], or other mechanism) Your job is to submit a risk diagnosis to the Centers for Medicare & Medicaid Services (CMS) for the purpose of payment. As part of this job, you use a process to verify the data is accurate. Your immediate supervisor tells you to ignore the Sponsor's process and to adjust or add risk diagnosis codes for certain individuals. What should you do? - -Report the