CPMA Compliance and Regulatory Guidelines (Ch. 1) Exam

CPMA Compliance and Regulatory Guidelines (Ch. 1) Exam Operation Restore Trust (ORT) - Correct ️️ * Two year partnership of federal and state agencies working together to protect the healthcare trust fund through shared intelligence and coordinated enforcement * Three agencies involved: The Office of the Inspector General (OIG), the Health Care Financing Administration (now CMS), and the Administration on Aging (AoA). * Program is now called Senior Medicare Patrol (CMP) with the HHS, CMS, and OIG working together to combat fraud and abuse. Fraud - Correct ️️ * CMS defines as knowingly making false statements or misrepresenting facts to obtain an undeserved benefit or payment from a federal health care plan. * Intentional * Examples include: 1) Billing for services and/or supplies that you know were not furnished or provided. 2) Altering claim forms and/or receipts to receive a higher payment amount. 3) Billing for services at a higher level than provided or necessary. 4) Misrepresenting the diagnosis to justify payment. 5) Making referrals for certain designated services that are prohibited. Abuse - Correct ️️ * CMS defines as an action resulting in unnecessary costs to a federal healthcare program, either directly or indirectly. * Unnecessary costs