ATI-Health Care Fraud, Waste, and
Abuse Prevention Exam 2025 Questions
and Answers
antitrust laws - --Answer --body of legislation that prohibits monopolies
and certain unfair business practices
balance billing - --Answer --practice of charging or collecting from a
Medicare beneficiary an amount in excess of the Medicare reimbursement rate for
Medicare-covered services or supplies
Centers of Medicare and Medicaid Services (CMS) - --Answer --federal
agency that administer the Medicare program and Medicaid programs and oversees
the Medicare Administrative Contractors involved in the processing and review of
Medicare claims at the first and second level of appeals
covered entity (CE) - --Answer --a health plan, a health care clearinghouse,
or a health care provider that transmits any health information in electronic form
in connection with a HIPPA transaction
....COPYRIGHT ©️ 2025 ALL RIGHTS RESERVED...TRUSTED & VERIFIED 1
, doctor shopping - --Answer --practice of requesting care from multiple
providers, often simultaneously, without coordinating care or informing the
providers of the multiple caregivers
drug formulary - --Answer --a list of prescription medications that a drug
plan will pay for
durable medical equipment (DME) - --Answer --devices that serve a medical
purpose, can withstand repeated use, and are appropriate for use in home health
care
Health Insurance Portability and Accountability Act (HIPAA) - --Answer --
Public Law 104-191, which includes the first nationally recognizable regulations for
the use and disclosure of an individual's health information and also allows people
to qualify immediately for comparable health insurance coverage when they change
their employment relationships
informatics - --Answer --technological resources, devices, and methods that
optimize the acquisition, storage, indexing, retrieval, and use of information and
data
kickback - --Answer --return of a part of a sum received for services because
of a prior agreement or coercion
....COPYRIGHT ©️ 2025 ALL RIGHTS RESERVED...TRUSTED & VERIFIED 2
Abuse Prevention Exam 2025 Questions
and Answers
antitrust laws - --Answer --body of legislation that prohibits monopolies
and certain unfair business practices
balance billing - --Answer --practice of charging or collecting from a
Medicare beneficiary an amount in excess of the Medicare reimbursement rate for
Medicare-covered services or supplies
Centers of Medicare and Medicaid Services (CMS) - --Answer --federal
agency that administer the Medicare program and Medicaid programs and oversees
the Medicare Administrative Contractors involved in the processing and review of
Medicare claims at the first and second level of appeals
covered entity (CE) - --Answer --a health plan, a health care clearinghouse,
or a health care provider that transmits any health information in electronic form
in connection with a HIPPA transaction
....COPYRIGHT ©️ 2025 ALL RIGHTS RESERVED...TRUSTED & VERIFIED 1
, doctor shopping - --Answer --practice of requesting care from multiple
providers, often simultaneously, without coordinating care or informing the
providers of the multiple caregivers
drug formulary - --Answer --a list of prescription medications that a drug
plan will pay for
durable medical equipment (DME) - --Answer --devices that serve a medical
purpose, can withstand repeated use, and are appropriate for use in home health
care
Health Insurance Portability and Accountability Act (HIPAA) - --Answer --
Public Law 104-191, which includes the first nationally recognizable regulations for
the use and disclosure of an individual's health information and also allows people
to qualify immediately for comparable health insurance coverage when they change
their employment relationships
informatics - --Answer --technological resources, devices, and methods that
optimize the acquisition, storage, indexing, retrieval, and use of information and
data
kickback - --Answer --return of a part of a sum received for services because
of a prior agreement or coercion
....COPYRIGHT ©️ 2025 ALL RIGHTS RESERVED...TRUSTED & VERIFIED 2
