ATI HEALTH CARE FRAUD, WASTE, AND ABUSE WITH 100% CORRECT ANSWERS

Which piece of legislation mandated the establishment of a joint Health Care Fraud and Abuse Control program? HIPAA When an employee is a provider's office suspects fraudulent activity and uses the Office of Inspector General Hotline to report it, the employee should do which of the following? -Stop filing suspicious bills and claims -Pursue knowledgeable legal counsel -Disengage professionally with the suspected perpetrator. -Report and return overpayments Which of the following agencies of the U.S. government has the authority to exclude individuals and entities from participating in federal health care programs? Office of Inspector General The OIG has the authority to exclude individuals and entities from federal health care programs for fraud and abuse that affect these programs or their beneficiaries. Which of the following is an example of a best practice strategy to prevent fraud, waste and abuse? Establish procedures for maintaining and distributing medication samples. If health care providers accept free drug samples from manufacturers, a best practice strategy to prevent fraud, waste, and abuse entails establishing procedures to prevent providers or employees from using free samples for personal gain (such as by selling them). HIPAA mandated that health care entities implement which of the following strategies to help reduce the Medicare fee-for-service error rate and prevent payment for potential fraudulent activity. Electronic Health Records Electronic health records reduce the errors from illegible or missing signatures on bills entities submit to health care insurance agencies. Plus, compared with manual records, they are far more likely to contain all the documentation to support the claim. According to recent estimates, which of the following sources of health care waste has had the largest financial impact? Unwarrant use of medical records or services This includes over-utilization of testing or inappropriate treatments, consumes an estimated $250 to $325 billion per year of health care expenditures. It carries the largest financial burden compared with other categories of fraud, waste, and abuse. Which of the following health care resources or services is the most vulnerable to fraud, waste and abuse? Durable medical equipment Durable medical equipment is extremely vulnerable to fraud, waste, and abuse bc providers can bill for high-cost items that patients do not want or need or even provide and then re-acquire them and sell them for a profit. Other highly vulnerable services include home health and infusion care.