CPMA Exam Latest 2026 Actual Questions and Verified
Answers A+ Verified
CMS Fraud Definition - ✔✔✔✔-Making false statements or
misrepresenting facts to obtain an undeserved benefit or
payment from a federal healthcare program
CMS Abuse Definition - ✔✔✔✔-An action that results in
unnecessary costs to a federal healthcare program, either
directly or indirectly
CMS Examples of Fraud - ✔✔✔✔-Billing for services and/or
supplies that you know were not furnished or provided,
altering claim forms and/or receipts to receive a higher
payment amount, billing a Medicare patient above the
allowed amount for services, billing for services at a higher
level than provided or necessary, misrepresenting the
diagnosis to justify payment
,When does the False Claims Act allow for reduced penalties?
- ✔✔✔✔-If the person committing the violation self-discloses
and provides all known info within 30 days, fully cooperates
with the investigation, and there is no criminal prosecution,
civil action, or administrative action regarding the violation
Qui Tam or "Whistleblower" provision - ✔✔✔✔-If an
individual (known as a "relator") knows of a violation of the
False Claims Act, he or she may bring a civil action on behalf
of him or herself and on behalf of the U.S. government; the
relator may be awarded 15-25% of the dollar amount
recovered
Stark or Physician Self-Referral Law - ✔✔✔✔-Bans physicians
from referring patients for certain services to entities in
which the physician or an immediate family member has a
direct or indirect financial relationship; bans the entity from
billing Medicare or Medicaid for the services provided as a
result of the self-referral
Anti-Kickback Law - ✔✔✔✔-Similar to the Stark Law but
imposes more severe penalties; states that whoever
knowingly or willfully solicits or receives any remuneration in
return for referring an individual to a person for the
furnishing or arranging of any item or service for which
payment may be made in whole or in part under a federal
healthcare program or in return for purchasing, leasing,
,ordering, or arranging for or recommending purchasing,
leasing, or ordering any good, facility, service, or item for
which payment may be made in whole or in part under a
federal healthcare program is guilty of a felony
CMS Examples of Abuse - ✔✔✔✔-Misusing codes on a claim,
charging excessively for services 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
False Claims Act - ✔✔✔✔-Any person is liable if they
knowingly present or cause to be presented a false or
fraudulent claim for payment or approval; knowingly makes,
uses, or causes to be made or used, a false record or material
to a false or fraudulent claims
Current False Claims Act penalties - ✔✔✔✔-$5,500-$11,000
per claim
Penalty for violating the Anti-Kickback Law - ✔✔✔✔-Up to
$25,000 fine and/or imprisonment of up to 5 years
, Stark Law vs. Anti-Kickback Law - ✔✔✔✔-Anti-Kickback
applies to anyone, not just physicians; the Anti-Kickback Law
requires proof of intention and states that the person must
"knowingly and willfully" violate the law.
Exclusion Statute - ✔✔✔✔-Under the Exclusion Statute, a
physician who is convicted of a criminal offense—such as
Medicare fraud (both misdemeanor and felony convictions),
patient abuse and neglect, or illegal distribution of controlled
substances—can be banned from participating in Medicare
by the OIG. Physicians who are excluded may not directly or
indirectly bill the federal government for the services they
provide to Medicare patients.
List of Excluded Individuals/Entities (LEIE) - ✔✔✔✔-Produced
and updated by the OIG; provides information regarding
individuals and entities currently excluded from participation
in Medicare, Medicaid, and all other federal healthcare
programs; sorts excluded individuals or entities by the legal
basis for the exclusion, the types of individuals and entities
that have been excluded, and the states where the excluded
individual resided at the time they were excluded or the state
in which the entity was doing business
Civil Monetary Penalties Law - ✔✔✔✔-The Social Security
Act authorizes the HHS to seek civil monetary penalties and
exclusion for certain behaviors. These penalties are enforced
Answers A+ Verified
CMS Fraud Definition - ✔✔✔✔-Making false statements or
misrepresenting facts to obtain an undeserved benefit or
payment from a federal healthcare program
CMS Abuse Definition - ✔✔✔✔-An action that results in
unnecessary costs to a federal healthcare program, either
directly or indirectly
CMS Examples of Fraud - ✔✔✔✔-Billing for services and/or
supplies that you know were not furnished or provided,
altering claim forms and/or receipts to receive a higher
payment amount, billing a Medicare patient above the
allowed amount for services, billing for services at a higher
level than provided or necessary, misrepresenting the
diagnosis to justify payment
,When does the False Claims Act allow for reduced penalties?
- ✔✔✔✔-If the person committing the violation self-discloses
and provides all known info within 30 days, fully cooperates
with the investigation, and there is no criminal prosecution,
civil action, or administrative action regarding the violation
Qui Tam or "Whistleblower" provision - ✔✔✔✔-If an
individual (known as a "relator") knows of a violation of the
False Claims Act, he or she may bring a civil action on behalf
of him or herself and on behalf of the U.S. government; the
relator may be awarded 15-25% of the dollar amount
recovered
Stark or Physician Self-Referral Law - ✔✔✔✔-Bans physicians
from referring patients for certain services to entities in
which the physician or an immediate family member has a
direct or indirect financial relationship; bans the entity from
billing Medicare or Medicaid for the services provided as a
result of the self-referral
Anti-Kickback Law - ✔✔✔✔-Similar to the Stark Law but
imposes more severe penalties; states that whoever
knowingly or willfully solicits or receives any remuneration in
return for referring an individual to a person for the
furnishing or arranging of any item or service for which
payment may be made in whole or in part under a federal
healthcare program or in return for purchasing, leasing,
,ordering, or arranging for or recommending purchasing,
leasing, or ordering any good, facility, service, or item for
which payment may be made in whole or in part under a
federal healthcare program is guilty of a felony
CMS Examples of Abuse - ✔✔✔✔-Misusing codes on a claim,
charging excessively for services 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
False Claims Act - ✔✔✔✔-Any person is liable if they
knowingly present or cause to be presented a false or
fraudulent claim for payment or approval; knowingly makes,
uses, or causes to be made or used, a false record or material
to a false or fraudulent claims
Current False Claims Act penalties - ✔✔✔✔-$5,500-$11,000
per claim
Penalty for violating the Anti-Kickback Law - ✔✔✔✔-Up to
$25,000 fine and/or imprisonment of up to 5 years
, Stark Law vs. Anti-Kickback Law - ✔✔✔✔-Anti-Kickback
applies to anyone, not just physicians; the Anti-Kickback Law
requires proof of intention and states that the person must
"knowingly and willfully" violate the law.
Exclusion Statute - ✔✔✔✔-Under the Exclusion Statute, a
physician who is convicted of a criminal offense—such as
Medicare fraud (both misdemeanor and felony convictions),
patient abuse and neglect, or illegal distribution of controlled
substances—can be banned from participating in Medicare
by the OIG. Physicians who are excluded may not directly or
indirectly bill the federal government for the services they
provide to Medicare patients.
List of Excluded Individuals/Entities (LEIE) - ✔✔✔✔-Produced
and updated by the OIG; provides information regarding
individuals and entities currently excluded from participation
in Medicare, Medicaid, and all other federal healthcare
programs; sorts excluded individuals or entities by the legal
basis for the exclusion, the types of individuals and entities
that have been excluded, and the states where the excluded
individual resided at the time they were excluded or the state
in which the entity was doing business
Civil Monetary Penalties Law - ✔✔✔✔-The Social Security
Act authorizes the HHS to seek civil monetary penalties and
exclusion for certain behaviors. These penalties are enforced
