Medicare Fraud, Waste, & Abuse Advanced Study Guide Test.
1. Your job is to submit a risk diagnosis to the Centers for Report the incident
to Medicare & Medicaid Services (CMS) for the purpose of 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 line or other
tells you to ignore the Sponsor's process and to mechanism)
adjust or add risk diagnosis codes for certain
individuals. What should you do?
a. Do what your immediate supervisor asked
you to do and adjust or add risk diagnosis codes
b. Report the incident to the compliance
department (via compliance hotline or other
mechanism) c.Discuss your concerns with your
immediate supervi- sor
d.Call law enforcement
2. Which of the following is NOT potentially a penalty
for violation of a law or regulation prohibiting fraud,
waste, and abuse (FWA)?
a. Civil Monetary Penalties Deportation
b. Exclusion from participation in all Federal
health care programs
c. Deportatio
3. Which of the following requires intent to obtain
pay- ment and the knowledge the actions are
wrong?
a.Frau
d Fraud
b.Wast
e
c.Abus
e
4.
1/
6
, Medicare Fraud, Waste, & Abuse Advanced Study Guide Test.
A person drops off a prescription for a beneficiary who Call the prescriber to
verify
is a "regular" customer. The prescription is for a the quantity
con- trolled substance with a quantity of 160. This
benefi- ciary normally receives a quantity of 60,
not 160. You review the prescription and have
concerns about pos- sible forgery. What is your
next step?
a. Call law enforcement
b. Call the prescriber to verify the quantity
c. Call the Sponsor's compliance department
d. Fill the prescription for 160
e. Fill the prescription for 60
5. You are performing a regular inventory of the con- Follow your pharmacy's
trolled substances in the pharmacy. You discover a
mi- nor inventory discrepancy. What should you procedures.
do?
a. Perform another review
b. Follow your pharmacy's procedures.
c. Call local law enforcement
d. Discuss your concerns with your supervisor
e. Contact your compliance department (via
compliance hotline or other mechanism)
6. You are in charge of paying claims submitted by
providers. You notice a certain diagnostic Consult with your imme-
provider ("Doe Diagnostics") requested a diate supervisor for next
substantial payment for a large number of steps or contact the
members. Many of these claims are for a certain com- pliance
procedure. You review the same type
department (via
compliance hotline,
Spe-
of procedure for other diagnostic providers and realize cial Investigations
Unit
2/
6
1. Your job is to submit a risk diagnosis to the Centers for Report the incident
to Medicare & Medicaid Services (CMS) for the purpose of 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 line or other
tells you to ignore the Sponsor's process and to mechanism)
adjust or add risk diagnosis codes for certain
individuals. What should you do?
a. Do what your immediate supervisor asked
you to do and adjust or add risk diagnosis codes
b. Report the incident to the compliance
department (via compliance hotline or other
mechanism) c.Discuss your concerns with your
immediate supervi- sor
d.Call law enforcement
2. Which of the following is NOT potentially a penalty
for violation of a law or regulation prohibiting fraud,
waste, and abuse (FWA)?
a. Civil Monetary Penalties Deportation
b. Exclusion from participation in all Federal
health care programs
c. Deportatio
3. Which of the following requires intent to obtain
pay- ment and the knowledge the actions are
wrong?
a.Frau
d Fraud
b.Wast
e
c.Abus
e
4.
1/
6
, Medicare Fraud, Waste, & Abuse Advanced Study Guide Test.
A person drops off a prescription for a beneficiary who Call the prescriber to
verify
is a "regular" customer. The prescription is for a the quantity
con- trolled substance with a quantity of 160. This
benefi- ciary normally receives a quantity of 60,
not 160. You review the prescription and have
concerns about pos- sible forgery. What is your
next step?
a. Call law enforcement
b. Call the prescriber to verify the quantity
c. Call the Sponsor's compliance department
d. Fill the prescription for 160
e. Fill the prescription for 60
5. You are performing a regular inventory of the con- Follow your pharmacy's
trolled substances in the pharmacy. You discover a
mi- nor inventory discrepancy. What should you procedures.
do?
a. Perform another review
b. Follow your pharmacy's procedures.
c. Call local law enforcement
d. Discuss your concerns with your supervisor
e. Contact your compliance department (via
compliance hotline or other mechanism)
6. You are in charge of paying claims submitted by
providers. You notice a certain diagnostic Consult with your imme-
provider ("Doe Diagnostics") requested a diate supervisor for next
substantial payment for a large number of steps or contact the
members. Many of these claims are for a certain com- pliance
procedure. You review the same type
department (via
compliance hotline,
Spe-
of procedure for other diagnostic providers and realize cial Investigations
Unit
2/
6
