FINAL WCC EXAM QUESTIONS WITH
COMPLETE SOLUTIONS152
Some experts estimate that health care fraud costs taxpayers and insurers ________ billion a
year. - ANSWERS-240
Boiler rooms with slick telemarketers offered full physicals for little or no fee. This free
diagnostic service turned out to be very costly because: - ANSWERS-information was used to file
claims against insurance companies and government insurance
The ripple effects of false medical diagnoses to get money include: - ANSWERS-person unable to
get life insurance
The phrase "cartel type frauds" used in connection with health care are frauds perpetrated by: -
ANSWERS-passing patients from doctor to doctor
Medicare is an easy mark for fraudulent equipment sales because: - ANSWERS-failure to
account for the legitimacy of suppliers
Equipment sales frauds work for all of the following reasons EXCEPT: - ANSWERS-Medicare does
not review doctor's credentials
Home care is a burgeoning business for scam artists. A company called Professional Care was
paid for all of the following EXCEPT: - ANSWERS-care for non-existent patients
Cost-shifting is: - ANSWERS-hospital room charges are reasonable but other charges are very
high
,Bounty hunters in the medical fraud area are: - ANSWERS-people who collect a fee for patient
referral
Patient referral firms known as headhunters go so far as to infiltrate: - ANSWERS-AA meetings
What Houston school personnel have been offered rewards to refer troubled students? -
ANSWERS-counselors
Certain public mental health facilities often face accusations of: - ANSWERS-neglect
American dialysis patients are how many times more likely to die in a given year as those in
Western Europe or Japan? - ANSWERS-2
Excessive billing can take several forms. What is overcharging? - ANSWERS-contracts for services
that exceed Medicare limits
Excessive billing can take several forms. What are retainers? - ANSWERS-upfront fees for
services covered by Medicare supplemental policies
Excessive billing can take several forms. What are waivers? - ANSWERS-patient paying directly
for services such as calls, refills, and conferences that Medicare considers covered
Some argue that nursing home abuse occurs for all of the following reasons EXCEPT: -
ANSWERS-unreasonable expectations of family members
Denial of Injury - ANSWERS-Claim no one got hurt/injured from their actions; Ex. A broker taking
a few thousand from extremely wealthy clients since they do not need that money as much as
him
,Denial of Victim - ANSWERS-Claim victim deserves the crime to happen to them; Ex. Someone
stealing from company when they do not feel appreciated because they barely compensate for
all their hard work
Appeal to Higher Loyalties - ANSWERS-When the offender believes the purpose for which they
are stealing is more ethical than the act; Usually when steals for family/loved ones; Ex. Stealing
company money to use for kid's college thinking how could they choose following a stupid law
over their own kids
Denial of Responsibility - ANSWERS-Shift blame to someone else so you cannot be held
responsible; Ex. Justifying your actions based on how you were trained
Condemning the Condemners - ANSWERS-Focus on regulators' short comings; Claiming the
criminal justice system is corrupt; Ex. Why would the government target your little tax evasion
when there are murderers and rapists causing more harm?
Inspector General of United States - ANSWERS-Created in 1978; Oversees and investigated
effectiveness, efficiency, waste, fraud, and abuse in federal programs for Congress; Basically, the
DA for WCC
Origins of WCC investigations - ANSWERS-Victim complaint; Whistleblowers; Financial
irregularities
Victim complaint - ANSWERS-Like most crimes, begins with victim coming to law enforcement
agency with a report of a crime
Whistleblower - ANSWERS-Someone who brings to public attention gross governmental
inefficiency or an illegal action
Financial irregularities - ANSWERS-Looking at odd tax returns, audits, etc. that looks like WCC
could be present; Some IRS algorithms can catch these
, Characteristics of Investigations - ANSWERS-Document intensive and long with boxes and boxes
of tax audits, files, etc.; More sophisticated crimes generally committed so needs to be
explained at length
Tools available to investigators - ANSWERS-Audits; Records review; Undercover investigations
Audits - ANSWERS-Verifications of financial/operational systems; Investigators look to these to
see how money is tracked; Establishes the "what" or actus reas
Records review - ANSWERS-Follows the paper trail of money; Ex. Bank accounts, Emails, Phone
calls; Establishes the "why" or mens rea
Undercover investigations - ANSWERS-Used usually after there is a reasonable suspicion of
criminal activity; When investigators pose as customer in scam or illegal activity; Effective way to
prove beyond reasonable doubt
Nominee account - ANSWERS-Common when trying to find money; When an account has a
different name than the one the controls that account; Way for people to prove that person
tried to hide funds
Challenges to White-Collar Prosecutions - ANSWERS-Speed of crime; Age of offense; Complexity
of crime
Age of offense - ANSWERS-Difficult for prosecutors because overtime records can get
lost/destroyed; Witnesses can leave or die before case reaches trial; Statute of limitations
Complexity of crime - ANSWERS-Not only does the prosecutor have to be able to understand
the crime, the jury has to understand, as well; Prosecutors, who studied law throughout school,
COMPLETE SOLUTIONS152
Some experts estimate that health care fraud costs taxpayers and insurers ________ billion a
year. - ANSWERS-240
Boiler rooms with slick telemarketers offered full physicals for little or no fee. This free
diagnostic service turned out to be very costly because: - ANSWERS-information was used to file
claims against insurance companies and government insurance
The ripple effects of false medical diagnoses to get money include: - ANSWERS-person unable to
get life insurance
The phrase "cartel type frauds" used in connection with health care are frauds perpetrated by: -
ANSWERS-passing patients from doctor to doctor
Medicare is an easy mark for fraudulent equipment sales because: - ANSWERS-failure to
account for the legitimacy of suppliers
Equipment sales frauds work for all of the following reasons EXCEPT: - ANSWERS-Medicare does
not review doctor's credentials
Home care is a burgeoning business for scam artists. A company called Professional Care was
paid for all of the following EXCEPT: - ANSWERS-care for non-existent patients
Cost-shifting is: - ANSWERS-hospital room charges are reasonable but other charges are very
high
,Bounty hunters in the medical fraud area are: - ANSWERS-people who collect a fee for patient
referral
Patient referral firms known as headhunters go so far as to infiltrate: - ANSWERS-AA meetings
What Houston school personnel have been offered rewards to refer troubled students? -
ANSWERS-counselors
Certain public mental health facilities often face accusations of: - ANSWERS-neglect
American dialysis patients are how many times more likely to die in a given year as those in
Western Europe or Japan? - ANSWERS-2
Excessive billing can take several forms. What is overcharging? - ANSWERS-contracts for services
that exceed Medicare limits
Excessive billing can take several forms. What are retainers? - ANSWERS-upfront fees for
services covered by Medicare supplemental policies
Excessive billing can take several forms. What are waivers? - ANSWERS-patient paying directly
for services such as calls, refills, and conferences that Medicare considers covered
Some argue that nursing home abuse occurs for all of the following reasons EXCEPT: -
ANSWERS-unreasonable expectations of family members
Denial of Injury - ANSWERS-Claim no one got hurt/injured from their actions; Ex. A broker taking
a few thousand from extremely wealthy clients since they do not need that money as much as
him
,Denial of Victim - ANSWERS-Claim victim deserves the crime to happen to them; Ex. Someone
stealing from company when they do not feel appreciated because they barely compensate for
all their hard work
Appeal to Higher Loyalties - ANSWERS-When the offender believes the purpose for which they
are stealing is more ethical than the act; Usually when steals for family/loved ones; Ex. Stealing
company money to use for kid's college thinking how could they choose following a stupid law
over their own kids
Denial of Responsibility - ANSWERS-Shift blame to someone else so you cannot be held
responsible; Ex. Justifying your actions based on how you were trained
Condemning the Condemners - ANSWERS-Focus on regulators' short comings; Claiming the
criminal justice system is corrupt; Ex. Why would the government target your little tax evasion
when there are murderers and rapists causing more harm?
Inspector General of United States - ANSWERS-Created in 1978; Oversees and investigated
effectiveness, efficiency, waste, fraud, and abuse in federal programs for Congress; Basically, the
DA for WCC
Origins of WCC investigations - ANSWERS-Victim complaint; Whistleblowers; Financial
irregularities
Victim complaint - ANSWERS-Like most crimes, begins with victim coming to law enforcement
agency with a report of a crime
Whistleblower - ANSWERS-Someone who brings to public attention gross governmental
inefficiency or an illegal action
Financial irregularities - ANSWERS-Looking at odd tax returns, audits, etc. that looks like WCC
could be present; Some IRS algorithms can catch these
, Characteristics of Investigations - ANSWERS-Document intensive and long with boxes and boxes
of tax audits, files, etc.; More sophisticated crimes generally committed so needs to be
explained at length
Tools available to investigators - ANSWERS-Audits; Records review; Undercover investigations
Audits - ANSWERS-Verifications of financial/operational systems; Investigators look to these to
see how money is tracked; Establishes the "what" or actus reas
Records review - ANSWERS-Follows the paper trail of money; Ex. Bank accounts, Emails, Phone
calls; Establishes the "why" or mens rea
Undercover investigations - ANSWERS-Used usually after there is a reasonable suspicion of
criminal activity; When investigators pose as customer in scam or illegal activity; Effective way to
prove beyond reasonable doubt
Nominee account - ANSWERS-Common when trying to find money; When an account has a
different name than the one the controls that account; Way for people to prove that person
tried to hide funds
Challenges to White-Collar Prosecutions - ANSWERS-Speed of crime; Age of offense; Complexity
of crime
Age of offense - ANSWERS-Difficult for prosecutors because overtime records can get
lost/destroyed; Witnesses can leave or die before case reaches trial; Statute of limitations
Complexity of crime - ANSWERS-Not only does the prosecutor have to be able to understand
the crime, the jury has to understand, as well; Prosecutors, who studied law throughout school,
