CDEO Chapter 3 Exam Questions with Correct Answers Latest Update 2025-2026
Documentation states that the patient had a "Status post hysterectomy. The patient presents
with a fever." Which of the following would be a compliant question to query? - Answers Do you
know the cause of the fever?
Operation Restore Trust - Answers 3 offices were involved: OIG, Healthcare Financing
Administration, AoA
May 1995 Bill Clinton: 2 yr partnership of federal and state agencies, working together to protect
the healthcare trust funds through shared intelligence coordinated enforcement, intended to
enhance quality of care for program's beneficiaries.
Program is not called Senior Medicare Patrol SMP
They work to combat fraud and abuse.
SMP - Answers Senior Medicare Patrol
OIG - Answers Office of Inspector General
AoA - Answers Administration on Aging
FCA - Answers False Claims Act
CMPL - Answers Civil Money Penalties Law
CMS Definition of Fraud - Answers knowingly making false statements or misrepresenting facts
to obtain an undeserved benefit or payment from a federal healthcare program
CMS Definition of Abuse - Answers an action resulting in unnecessary costs to a federal
healthcare program either directly or indirectly
CMS Examples of Fraud - Answers Billing for Services/Supplies that you know were not
furnished or provided
Altering claim forms and/or receipts to receive a higher payment amount
Billing for services at a level higher than provided or necessary
,Misrepresenting the diagnosis to justify payment
Making referrals to certain designated services that are prohibited
CMS Examples of Abuse - Answers Misusing codes on claims
Charging excessively for service 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
FCA - Answers Federal
False Claims Act
Lincoln Law - Answers False Claims Act, enacted 1863 to combat fraud from suppliers of good
to the Union Army during the Civil War
In 1943 amendments made it more difficult to bring action forward.
In 1986 Congress enacted an overhaul that generated new fraud investigations and actions.
The Statute is in title 31, subtitle III, CH. 37, subchapter III, of the US code 31 U.S.C. 3729(a).1
, Title 31 Statute's 7 Types of Conduct - Answers that brings liability FCA
It states a person is liable who:
A) Knowingly presents, or causes to be presented, a false or fraudulent claim for payment or
approval;
B) Knowingly makes , uses, or causes to be made or used, a false record or statement material
to a false or fraudulent claim
Title 31 Statute's 7 Types of Conduct - Answers C) Conspires to a violation of subparagraph (A),
(B), (E), (F), or (G);
D) Has posession, custody, or control of property or money used, or to be used, by the
government and knowingly delivers, or causes to be delivered , less than all of that money or
property;
Title 31 Statute's 7 Types of Conduct - Answers E) Is authorized to make or deliver a document
certifying receipt of property used, or to be used, by the government, and intending to defraud
the government, makes or delivers the receipt without completely knowing that the information
on the receipt is true
F) Knowingly buys or receives as a pledge of an obligation or debt, public property from an
officer or employee of the government or a member of the Armed Forces, who lawfully may not
sell or pledge property
Title 31 Statute's 7 Types of Conduct - Answers G) Knowingly makes, uses, or causes to be
made or used, a false record or statement material to an obligation to pay or transmit money or
property to the government, or knowingly conceals or knowingly and improperly avoids or
decreases an obligation to pay to transmit money or property to the government
FCA Fraud & Misconduct - Answers -Falsifying a medical chart notation
-Submitting claims for services not performed, not request, not necessary
-Submitting claims for expired drugs
-Upcoding and/or unbundling services
Documentation states that the patient had a "Status post hysterectomy. The patient presents
with a fever." Which of the following would be a compliant question to query? - Answers Do you
know the cause of the fever?
Operation Restore Trust - Answers 3 offices were involved: OIG, Healthcare Financing
Administration, AoA
May 1995 Bill Clinton: 2 yr partnership of federal and state agencies, working together to protect
the healthcare trust funds through shared intelligence coordinated enforcement, intended to
enhance quality of care for program's beneficiaries.
Program is not called Senior Medicare Patrol SMP
They work to combat fraud and abuse.
SMP - Answers Senior Medicare Patrol
OIG - Answers Office of Inspector General
AoA - Answers Administration on Aging
FCA - Answers False Claims Act
CMPL - Answers Civil Money Penalties Law
CMS Definition of Fraud - Answers knowingly making false statements or misrepresenting facts
to obtain an undeserved benefit or payment from a federal healthcare program
CMS Definition of Abuse - Answers an action resulting in unnecessary costs to a federal
healthcare program either directly or indirectly
CMS Examples of Fraud - Answers Billing for Services/Supplies that you know were not
furnished or provided
Altering claim forms and/or receipts to receive a higher payment amount
Billing for services at a level higher than provided or necessary
,Misrepresenting the diagnosis to justify payment
Making referrals to certain designated services that are prohibited
CMS Examples of Abuse - Answers Misusing codes on claims
Charging excessively for service 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
FCA - Answers Federal
False Claims Act
Lincoln Law - Answers False Claims Act, enacted 1863 to combat fraud from suppliers of good
to the Union Army during the Civil War
In 1943 amendments made it more difficult to bring action forward.
In 1986 Congress enacted an overhaul that generated new fraud investigations and actions.
The Statute is in title 31, subtitle III, CH. 37, subchapter III, of the US code 31 U.S.C. 3729(a).1
, Title 31 Statute's 7 Types of Conduct - Answers that brings liability FCA
It states a person is liable who:
A) Knowingly presents, or causes to be presented, a false or fraudulent claim for payment or
approval;
B) Knowingly makes , uses, or causes to be made or used, a false record or statement material
to a false or fraudulent claim
Title 31 Statute's 7 Types of Conduct - Answers C) Conspires to a violation of subparagraph (A),
(B), (E), (F), or (G);
D) Has posession, custody, or control of property or money used, or to be used, by the
government and knowingly delivers, or causes to be delivered , less than all of that money or
property;
Title 31 Statute's 7 Types of Conduct - Answers E) Is authorized to make or deliver a document
certifying receipt of property used, or to be used, by the government, and intending to defraud
the government, makes or delivers the receipt without completely knowing that the information
on the receipt is true
F) Knowingly buys or receives as a pledge of an obligation or debt, public property from an
officer or employee of the government or a member of the Armed Forces, who lawfully may not
sell or pledge property
Title 31 Statute's 7 Types of Conduct - Answers G) Knowingly makes, uses, or causes to be
made or used, a false record or statement material to an obligation to pay or transmit money or
property to the government, or knowingly conceals or knowingly and improperly avoids or
decreases an obligation to pay to transmit money or property to the government
FCA Fraud & Misconduct - Answers -Falsifying a medical chart notation
-Submitting claims for services not performed, not request, not necessary
-Submitting claims for expired drugs
-Upcoding and/or unbundling services
