CDEO COMPREHENSIVE EXAM QUESTIONS
AND CORRECT ANSWERS STUDY GUIDE
●● Operation Restore Trust
Answer: 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
Answer: Senior Medicare Patrol
●● OIG
Answer: Office of Inspector General
●● AoA
,Answer: Administration on Aging
●● FCA
Answer: False Claims Act
●● CMPL
Answer: Civil Money Penalties Law
●● CMS Definition of Fraud
Answer: knowingly making false statements or misrepresenting facts to
obtain an undeserved benefit or payment from a federal healthcare
program
●● CMS Definition of Abuse
Answer: an action resulting in unnecessary costs to a federal healthcare
program either directly or indirectly
●● CMS Examples of Fraud
Answer: 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
Answer: 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
Answer: Federal
AND CORRECT ANSWERS STUDY GUIDE
●● Operation Restore Trust
Answer: 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
Answer: Senior Medicare Patrol
●● OIG
Answer: Office of Inspector General
●● AoA
,Answer: Administration on Aging
●● FCA
Answer: False Claims Act
●● CMPL
Answer: Civil Money Penalties Law
●● CMS Definition of Fraud
Answer: knowingly making false statements or misrepresenting facts to
obtain an undeserved benefit or payment from a federal healthcare
program
●● CMS Definition of Abuse
Answer: an action resulting in unnecessary costs to a federal healthcare
program either directly or indirectly
●● CMS Examples of Fraud
Answer: 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
Answer: 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
Answer: Federal
