Fraud Abuse and Waste questions with correct answers

WHat's the problem with healthcare fraud and abuse? CORRECT ANSWER $765 billion per year has been lost due to fraud, abuse, and waste. ($75 billion is due to fraud) - overutilization of services and increased costs for payers - corrupts medical decision‐making -can lead to unfair competition in the marketplace - puts patients' health and welfare at risk by potentially exposing them to unnecessary services and ultimately taking money away from necessary care ROI for Health Care Fraud and Abuse Control program (HCFAC): CORRECT ANSWER - $1.00 spent on fighting fraud, abuse, and waste, $8.10 is returned. - 2013 : recovered $4.3 billion and was able to return that money to the Medicare Trust Fund to pay for legitimate care What is fraud? CORRECT ANSWER obtaining something of value for which you are not entitled through intentional deception or misrepresentation of material facts Example of of fraud include CORRECT ANSWER • Knowingly billing for services that were never furnished • Knowingly altering claim forms to receive more payment • Falsifying documentation to receive payment for which you are not entitled What is abuse? CORRECT ANSWER involves payment for items or services for which there is no entitlement. In contrast to fraud, abuse involves instances in which the provider has not intentionall