AHIP FRAUD Final Exam
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. - ANS-True
Once a corrective action plan is started, the corrective action plan must be monitored
annually to ensure they are effective. - ANS-False
These are examples of issues that should be reported to a Compliance Department:
suspected fraud, waste, and abuse (FWA); potential
health privacy violation, unethical behavior, and employee misconduct. - ANS-True
What are some of the penalties for violating fraud, waste, and abuse (FWA) laws? -
ANS-All of the above
Some of the laws governing Medicare Part C and D fraud, waste, and abuse (FWA)
include the Health Insurance Portability and
Accountability Act (HIPAA), the Civil False Claims Act, the Anti-Kickback Statute, and
the Criminal Health Care Fraud Statute. - ANS-True
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. - ANS-False
Ways to report potential fraud, waste, and abuse (FWA) include: - ANS-All of the above
You can help prevent fraud, waste, and abuse (FWA) by doing all the following:
Look for suspicious activity
Conduct yourself in an ethical manner
Ensure accurate and timely data and 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
Verify all information provided to you - ANS-True
Bribes or kickbacks of any kind for services that are paid under a Federal health care
program (which includes Medicare) constitute fraud
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. - ANS-True
Once a corrective action plan is started, the corrective action plan must be monitored
annually to ensure they are effective. - ANS-False
These are examples of issues that should be reported to a Compliance Department:
suspected fraud, waste, and abuse (FWA); potential
health privacy violation, unethical behavior, and employee misconduct. - ANS-True
What are some of the penalties for violating fraud, waste, and abuse (FWA) laws? -
ANS-All of the above
Some of the laws governing Medicare Part C and D fraud, waste, and abuse (FWA)
include the Health Insurance Portability and
Accountability Act (HIPAA), the Civil False Claims Act, the Anti-Kickback Statute, and
the Criminal Health Care Fraud Statute. - ANS-True
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. - ANS-False
Ways to report potential fraud, waste, and abuse (FWA) include: - ANS-All of the above
You can help prevent fraud, waste, and abuse (FWA) by doing all the following:
Look for suspicious activity
Conduct yourself in an ethical manner
Ensure accurate and timely data and 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
Verify all information provided to you - ANS-True
Bribes or kickbacks of any kind for services that are paid under a Federal health care
program (which includes Medicare) constitute fraud
