COMBATING MEDICARE PARTS C AND D FRAUD, WASTE, AND ABUSE

Bribes or kickbacks of any kind for services that are paid under a Federal healthcare program (which includes Medicare) constitute fraud by the person making as well as the person receiving them. - Answer- True Once a corrective action plan is started, the corrective actions must be monitored annually to ensure they are effective. - Answer- 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. - Answer- False Waste indicates 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. - Answer- 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. - Answer- True 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. - Answer- True Ways to report 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) - Answer- E. All of the above 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. - Answer- True 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 Claim Act; the Anti-Kickback Statute; the List of Excluded Individuals and Entities (LEIE); and the Health Care Fraud Statute. - Answer- False You can help prevent fraud, waste, and abuse (FWA) by doing all of the following: