CPMA Exam Correct Questions And Answers

CMS Fraud Definition - ANSWER Making false statements or misrepresenting facts to obtain an undeserved benefit or payment from a federal healthcare program CMS Fraud Definition - ANSWER Making false statements or misrepresenting facts to obtain an undeserved benefit or payment from a federal healthcare program CMS Abuse Definition - ANSWER An action that results in unnecessary costs to a federal healthcare program, either directly or indirectly CMS Abuse Definition - ANSWER An action that results in unnecessary costs to a federal healthcare program, either directly or indirectly CMS Examples of Fraud - ANSWER 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 CMS Examples of Fraud - ANSWER 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 CMS Examples of Abuse - ANSWER 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 CMS Examples of Abuse - ANSWER 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 - ANSWER 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