CPMA Exam Questions and Answers
(100% Pass)
CMS Fraud Definition
Making false statements or misrepresenting facts to obtain an undeserved
benefit or payment from a federal healthcare program
CMS Abuse Definition
An action that results in unnecessary costs to a federal healthcare program,
either directly or indirectly
CMS Examples of Fraud
Billing for services and/or supplies that you know were not furnished or
provided, altering claim forms and/or receipts to receive a higher payment amount,
billing a Medicare patient above the allowed amount for services, billing for
services at a higher level than provided or necessary, misrepresenting the diagnosis
to justify payment
CMS Examples of Abuse
,Master01 | October, 2025/2026| Latest update
Misusing codes on a claim, charging excessively for services or supplies,
billing for services that were not medically necessary, failure to maintain adequate
medical or financial records, improper billing
practices, billing Medicare patients a higher fee schedule than non- Medicare
patients
False Claims Act
Any person is liable if they knowingly present or cause to be presented a
false or fraudulent claim for payment or approval; knowingly makes, uses, or
causes to be made or used, a false record or material to a false or fraudulent claims
Current False Claims Act penalties
$10,957-$21,916 per claim plus three times the amount of damages
When does the False Claims Act allow for reduced penalties?
If the person committing the violation self-discloses and provides all
,known info within 30 days, fully cooperates with the investigation, and there is no
criminal prosecution, civil action, or administrative action regarding the violation
Qui Tam or "Whistleblower" provision
Master01 | October, 2025/2026| Latest update
If an individual (known as a "relator") knows of a violation of the False
Claims Act, he or she may bring a civil action on behalf of him or herself and on
behalf of the U.S. government; the relator may be
awarded 15-25% of the dollar amount recovered
Stark or Physician Self-Referral Law
Bans dphysicians dfrom dreferring dpatients dfor dcertain dservices dto dentities din
dwhich dthe dphysician dor dan dimmediate dfamily dmember dhas da ddirect dor dindirect
dfinancial drelationship; dbans dthe dentity dfrom dbilling dMedicare dor dMedicaid dfor
dthe dservices dprovided das da dresult dof dthe dself-referral
Anti-Kickback dLaw
Similar dto dthe dStark dLaw dbut dimposes dmore dsevere dpenalties; dstates dthat
dwhoever dknowingly dor dwillfully dsolicits dor dreceives dany dremuneration din
, return dfor dreferring dan dindividual dto da dperson dfor dthe dfurnishing dor darranging
dof dany ditem dor dservice dfor dwhich dpayment dmay dbe dmade din dwhole dor din dpart
dunder da dfederal dhealthcare dprogram dor din dreturn dfor dpurchasing, dleasing,
dordering, dor darranging dfor dor drecommending
purchasing, dleasing, dor dordering dany dgood, dfacility, dservice, dor ditem dfor dwhich
dpayment dmay dbe dmade din dwhole dor din dpart dunder da dfederal dhealthcare
dprogram dis dguilty dof da dfelony
Master01 d| dOctober, d2025/2026| dLatest dupdate
d
Penalty dfor dviolating dthe dAnti-Kickback dLaw
Up dto d$25,000 dfine dand/or dimprisonment dof dup dto d5 dyears
Stark dLaw dvs. dAnti-Kickback dLaw
Anti-Kickback dapplies dto danyone, dnot djust dphysicians; dthe dAnti-Kickback
dLaw drequires dproof dof dintention dand dstates dthat dthe dperson dmust
"knowingly dand dwillfully" dviolate dthe dlaw.
Penalties dfor dthe dStark dLaw
(100% Pass)
CMS Fraud Definition
Making false statements or misrepresenting facts to obtain an undeserved
benefit or payment from a federal healthcare program
CMS Abuse Definition
An action that results in unnecessary costs to a federal healthcare program,
either directly or indirectly
CMS Examples of Fraud
Billing for services and/or supplies that you know were not furnished or
provided, altering claim forms and/or receipts to receive a higher payment amount,
billing a Medicare patient above the allowed amount for services, billing for
services at a higher level than provided or necessary, misrepresenting the diagnosis
to justify payment
CMS Examples of Abuse
,Master01 | October, 2025/2026| Latest update
Misusing codes on a claim, charging excessively for services or supplies,
billing for services that were not medically necessary, failure to maintain adequate
medical or financial records, improper billing
practices, billing Medicare patients a higher fee schedule than non- Medicare
patients
False Claims Act
Any person is liable if they knowingly present or cause to be presented a
false or fraudulent claim for payment or approval; knowingly makes, uses, or
causes to be made or used, a false record or material to a false or fraudulent claims
Current False Claims Act penalties
$10,957-$21,916 per claim plus three times the amount of damages
When does the False Claims Act allow for reduced penalties?
If the person committing the violation self-discloses and provides all
,known info within 30 days, fully cooperates with the investigation, and there is no
criminal prosecution, civil action, or administrative action regarding the violation
Qui Tam or "Whistleblower" provision
Master01 | October, 2025/2026| Latest update
If an individual (known as a "relator") knows of a violation of the False
Claims Act, he or she may bring a civil action on behalf of him or herself and on
behalf of the U.S. government; the relator may be
awarded 15-25% of the dollar amount recovered
Stark or Physician Self-Referral Law
Bans dphysicians dfrom dreferring dpatients dfor dcertain dservices dto dentities din
dwhich dthe dphysician dor dan dimmediate dfamily dmember dhas da ddirect dor dindirect
dfinancial drelationship; dbans dthe dentity dfrom dbilling dMedicare dor dMedicaid dfor
dthe dservices dprovided das da dresult dof dthe dself-referral
Anti-Kickback dLaw
Similar dto dthe dStark dLaw dbut dimposes dmore dsevere dpenalties; dstates dthat
dwhoever dknowingly dor dwillfully dsolicits dor dreceives dany dremuneration din
, return dfor dreferring dan dindividual dto da dperson dfor dthe dfurnishing dor darranging
dof dany ditem dor dservice dfor dwhich dpayment dmay dbe dmade din dwhole dor din dpart
dunder da dfederal dhealthcare dprogram dor din dreturn dfor dpurchasing, dleasing,
dordering, dor darranging dfor dor drecommending
purchasing, dleasing, dor dordering dany dgood, dfacility, dservice, dor ditem dfor dwhich
dpayment dmay dbe dmade din dwhole dor din dpart dunder da dfederal dhealthcare
dprogram dis dguilty dof da dfelony
Master01 d| dOctober, d2025/2026| dLatest dupdate
d
Penalty dfor dviolating dthe dAnti-Kickback dLaw
Up dto d$25,000 dfine dand/or dimprisonment dof dup dto d5 dyears
Stark dLaw dvs. dAnti-Kickback dLaw
Anti-Kickback dapplies dto danyone, dnot djust dphysicians; dthe dAnti-Kickback
dLaw drequires dproof dof dintention dand dstates dthat dthe dperson dmust
"knowingly dand dwillfully" dviolate dthe dlaw.
Penalties dfor dthe dStark dLaw
