Medicare Fraud, Waste and Abuse Complete Study Guide
Solution Test.
1. Which of the following requires intent to obtain
pay- ment and the knowledge the actions are Fraud
wrong? Question 1Select one:
a.Abus
e
b.Frau
d
c.Wast
e
2. Your job is to submit a risk diagnosis to the Centers for D - Report the
incident Medicare & Medicaid Services (CMS) for the purpose of to the
compliance depart- payment. As part of this job, you use a process to verify
ment (via compliance hot-
the data is accurate. Your immediate supervisor tells line or other mechanism)
you to ignore the Sponsor's process and to adjust
or add risk diagnosis codes for certain individuals.
What should you do?
Question 2Select one:
a. Call law enforcement
b. Discuss your concerns with your immediate
supervi- sor
c. Do what your immediate supervisor asked
you to do and adjust or add risk diagnosis codes
d. Report the incident to the compliance
department (via compliance hotline or other
mechanism)
3. Which of the following is NOT potentially a
penalty for violation of a law or regulation
prohibiting fraud, waste, and abuse (FWA)? Deportation
Question 3Select one:
a.Deportation
b. Exclusion from participation in all Federal health
care programs
c. Civil Monetary Penalties
1/
5
, Medicare Fraud, Waste and Abuse Complete Study Guide
Solution Test.
4. A person drops off a prescription for a Call the prescriber to
beneficiary who is a "regular" customer. The
prescription is for a controlled substance with a verify the quantity
quantity of 160. This
beneficiary normally receives a quantity of 60, not
160. You review the prescription and have
concerns about possible forgery. What is your
next step?
Question 4Select one:
a.Fill the prescription for 60
b. Fill the prescription for 160
c. Call the Sponsor's compliance department
d. Call law enforcement
e. Call the prescriber to verify the quantity
5. You are performing a regular inventory of the Follow your
con- trolled substances in the pharmacy. You pharmacy's
discover a minor inventory discrepancy. What procedures.
should you do? Question Select one:
a.Perform another review
b. Follow your pharmacy's procedures.
c. Contact your compliance department (via
compli- ance hotline or other mechanism)
d. Discuss your concerns with your supervisor
e. Call local law enforcement
6. You are in charge of paying claims submitted by
providers. You notice a certain diagnostic
provider ("Doe Diagnostics") requested a
substantial payment for a large patient group. Reject the claims
Many of these claims are for a certain procedure.
You review the same type of procedure for other
diagnostic providers and realize Doe Diagnostics'
claims far exceed any other provider
2/
5
Solution Test.
1. Which of the following requires intent to obtain
pay- ment and the knowledge the actions are Fraud
wrong? Question 1Select one:
a.Abus
e
b.Frau
d
c.Wast
e
2. Your job is to submit a risk diagnosis to the Centers for D - Report the
incident Medicare & Medicaid Services (CMS) for the purpose of to the
compliance depart- payment. As part of this job, you use a process to verify
ment (via compliance hot-
the data is accurate. Your immediate supervisor tells line or other mechanism)
you to ignore the Sponsor's process and to adjust
or add risk diagnosis codes for certain individuals.
What should you do?
Question 2Select one:
a. Call law enforcement
b. Discuss your concerns with your immediate
supervi- sor
c. Do what your immediate supervisor asked
you to do and adjust or add risk diagnosis codes
d. Report the incident to the compliance
department (via compliance hotline or other
mechanism)
3. Which of the following is NOT potentially a
penalty for violation of a law or regulation
prohibiting fraud, waste, and abuse (FWA)? Deportation
Question 3Select one:
a.Deportation
b. Exclusion from participation in all Federal health
care programs
c. Civil Monetary Penalties
1/
5
, Medicare Fraud, Waste and Abuse Complete Study Guide
Solution Test.
4. A person drops off a prescription for a Call the prescriber to
beneficiary who is a "regular" customer. The
prescription is for a controlled substance with a verify the quantity
quantity of 160. This
beneficiary normally receives a quantity of 60, not
160. You review the prescription and have
concerns about possible forgery. What is your
next step?
Question 4Select one:
a.Fill the prescription for 60
b. Fill the prescription for 160
c. Call the Sponsor's compliance department
d. Call law enforcement
e. Call the prescriber to verify the quantity
5. You are performing a regular inventory of the Follow your
con- trolled substances in the pharmacy. You pharmacy's
discover a minor inventory discrepancy. What procedures.
should you do? Question Select one:
a.Perform another review
b. Follow your pharmacy's procedures.
c. Contact your compliance department (via
compli- ance hotline or other mechanism)
d. Discuss your concerns with your supervisor
e. Call local law enforcement
6. You are in charge of paying claims submitted by
providers. You notice a certain diagnostic
provider ("Doe Diagnostics") requested a
substantial payment for a large patient group. Reject the claims
Many of these claims are for a certain procedure.
You review the same type of procedure for other
diagnostic providers and realize Doe Diagnostics'
claims far exceed any other provider
2/
5
