Fraud, Waste, Abuse FWA - 2, Fraud Waste and Abuse, Preventing Fraud, Abuse & Waste, Fraud, Abuse, and Waste, Fraud Waste and Abuse 2018 AHIP, fraud, waste, and abuse prevention. Top Questions and answers, 100% Accurate.

Fraud, Waste, Abuse FWA - 2, Fraud Waste and Abuse, Preventing Fraud, Abuse & Waste, Fraud, Abuse, and Waste, Fraud Waste and Abuse 2018 AHIP, fraud, waste, and abuse prevention. Top Questions and answers, 100% Accurate. e - -Ways to report potential Fraud, Waste, and Abuse (FWA) include: a. Telephone hotlines b. Mail Drops c. In-person reporting to the compliance department/supervisor d. Special Investigations Units (SIUs) e. All of the above false - -Once a corrective action plan is started, the corrective actions must be monitored annually to ensure they are effective. : True False false - -Any person who knowingly submits false claims to the Government is liable for five times the Government's damages caused by the violator plus a penalty. : True False true - -These are examples of issues that should be reported to a Compliance Department: suspected Fraud, Waste, and Abuse (FWA); potential health privacy violation, and unethical behavior/employee misconduct. : True False true - -Bribes or kickbacks of any kind for services that are paid under a Federal health care program (which includes Medicare) constitute fraud by the person making as well as the person receiving them. : True False true - -Waste includes any misuse of resources such as the overuse of services, or other practices that, directly or indirectly, result in unnecessary costs to the Medicare Program. : True False ACA Section 1557 differs from earlier legislation in providing broader protection against discrimination based on - -sex Section 1557 of the Affordable Care Act applies to - -c. all health programs and activities administered by or receiving federal financial assistance from HHS. Correct Which Medicare programs are covered by ACA Section 1557? - -a. Parts A, C, and D, but not B. Correct Under ACA Section 1557, prohibited actions involve - -d. eligibility, claims, and marketing. Correct Under ACA Section 1557, a person - -c. cannot be discriminated against based on her legal or illegal immigration status or ability to speak English. Correct Under ACA Section 1557, a health plan - -d. cannot deny coverage to LEP individuals and is required to provide language assistance to them, free of charge. Correct Which of these actions is most likely to be permitted in dealing with a person with limited English proficiency? - -a. Allowing a child to interpret in an emergency. Correct Under ACA Section 1557, sex discrimination includes a person's - -c. sex, pregnancy, sex stereotypes, or gender identity. Correct Under ACA Section 1557, a health plan sold through a state exchange may, based on an individual's age, - -d. charge higher premiums. Correct ACA Section 1557 rules for disability concern - -d. Policies and procedures, physical access, and communication. Correct Which area of potential discrimination is not generally covered by ACA Section 1557? - -c. Employment (with the exception of the provision of health insurance). Correct As a result of violations of ACA Section 1557 nondiscrimination rules, - -c. a health plan may revoke an agent or broker's appointment with the health plan. Correct For a health plan, what are the possible consequences of violations of ACA Section 1557? - -b. Loss of federal business and compensatory damages. Correct If a health plan violates ACA Section 1557 nondiscrimination protections, it may be - -c. required to take corrective action and sometimes pay damages, and it may be sued by individuals. Correct Ways to report potential Fraud, Waste, and Abuse (FWA) include: - -e. All of the above Correct Once a corrective action plan is started, the corrective actions must be monitored annually to ensure they are effective. - -False Any person who knowingly submits false claims to the Government is liable for five times the Government's damages caused by the violator plus a penalty. - -False These are examples of issues that should be reported to a Compliance Department: suspected Fraud, Waste, and Abuse (FWA); potential health privacy violation, and unethical behavior/employee misconduct. - -True Bribes or kickbacks of any kind for services that are paid under a Federal health care program (which includes Medicare) constitute fraud by the person making as well as the person receiving them. - -True Correct Waste includes any misuse of resources such as the overuse of services, or other practices that, directly or indirectly, result in unnecessary costs to the Medicare Program. - -True You can help prevent Fraud, Waste, and Abuse (FWA) by doing all of the following: • Look for suspicious activity; • Conduct yourself in an ethical manner; • Ensure accurate and timely data/billing; • Ensure you coordinate with other payers; • Keep up to date with FWA policies and procedures, standards of conduct, laws, regulations, and the Centers for Medicare & Medicaid Services (CMS) guidance; and • Verify all information provided to you. - -F What are some of the penalties for violating Fraud, Waste, and Abuse (FWA) laws? - -all of the above Some of the laws governing Medicare Parts C and D Fraud, Waste, and Abuse (FWA) include the Health Insurance Portability and Accountability Act (HIPAA); the False Claims Act; the Anti-Kickback Statute; the List of Excluded Individuals and Entities (LEIE); and the Health Care Fraud Statute. - -false Abuse involves payment for items or services when there is no legal entitlement to that payment and the provider has not knowingly and/or intentionally misrepresented facts to obtain payment. - -false Compliance is the responsibility of the Compliance Officer, Compliance Committee, and Upper Management only. - -False Ways to report a compliance issue include: - -All of the Above What is the policy of non-retaliation? - -Protects employees who, in good faith, report suspected non-compliance These are examples of issues that can be reported to a Compliance Department: suspected Fraud, Waste, and Abuse (FWA); potential health privacy violation, and unethical behavior/employee misconduct. - -True Once a corrective action plan begins addressing non-compliance or Fraud, Waste, and Abuse (FWA) committed by a Sponsor's employee or First-Tier, Downstream, or Related Entity's (FDR's) employee, ongoing monitoring of the corrective actions is not necessary. - -True At a minimum, an effective compliance program includes four core requirements. - -False Standards of Conduct are the same for every Medicare Parts C and D Sponsor. - -T Medicare Parts C and D plan Sponsors are not required to have a compliance program. - -True What are some of the consequences for non-compliance, fraudulent, or unethical behavior? - -All of the Above Correcting non-compliance ______________. - -just A Fraud - --intentional deception or misrepresentation that a person makes to gain a benefit to which they are not entitled -ex: falsifying documentation Abuse - --payment for items or services that the provider is not entitled to and for which the provider has not intentionally misrepresented facts to obtain payment -ex: billing services that are not medical necessary Waste - --incurring unnecessary costs as a result of deficient management practices, systems, or controls -ex: duplication of services already provided elsewhere False Claims Act - --prohibits "knowing" submission of false claims or the use of a false record or statement for payment to Medicare/Medicaid -"knowing": includes actual knowledge, deliberate ignorance, and reckless disregard Federal Anti-Kickback Statute - --prohibits anyone from "knowingly & willfully" offering or receiving a form of payment in return for referring a pt to another provider for services covered by Medicare/Medicaid -ex: cash for referrals, gifts, etc. Physician Self-Referral Law - --prohibits physician referrals for certain health care services (PT) when there is a financial relationship with an entity unless an exception applies -financial relationships include ownership and compensation Exclusion Authorities/Statute - --the government may exclude inviolate providers from participation in federal health care programs, meaning: the provider may not bill for treating patients & an employer may not bill for the provider's services Civil Monetary Penalty Law - --providing free services to patients or waiving coinsurance and deductibles is generally prohibited as it may influence a patient to receive your services -exception for financially needy patients (pro-bono service) Compliance Program - -1) written standards of conduct, policies, and procedures 2) a compliance officer 3) education and training 4) hotline to receive complaints 5) system to respond to allegations of illegal activities 6) audits to monitor compliance 7) investigation & remediation of identified systemic problems Taking Action - --contact the compliance officer -stop submitting problematic bills -seek legal counsel -determine whether there are any overpayments to be returned -disentangle yourself from problematic relationships Any person who knowingly submits false claims to the Government is liable for five times the Government's damages caused by the violator plus a penalty. - -False