CPMA EXAM ACTUAL EXAM PAPER 2026
QUESTIONS AND ANSWERS 100% CORRECT
GRADED A+
⩥ 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 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
,⩥ Current False Claims Act penalties. Answer: $5,500-$11,000 per
claim
⩥ When does the False Claims Act allow for reduced penalties?.
Answer: 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. Answer: 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. Answer: 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. Answer: 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
⩥ Penalty for violating the Anti-Kickback Law. Answer: Up to $25,000
fine and/or imprisonment of up to 5 years
⩥ Stark Law vs. Anti-Kickback Law. Answer: 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. Answer: 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). Answer: 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. Answer: The Social Security Act
authorizes the HHS to seek civil monetary penalties and exclusion for
certain behaviors. These penalties are enforced by the OIG through the
Civil Monetary Penalties (CMP) Law. The severity of penalties and
monetary amounts charged depend on the type of conduct engaged in by
the physician. A physician can incur a CMP in the following ways:
Presenting or causing claims to be presented to a federal healthcare
program that the person knows or should know is for an item or service
that was not provided as claimed or is false or fraudulent.Violating the
Anti-Kickback Statute by knowingly and willfully (1) offering or paying
remuneration to induce the referral of federal healthcare program
business, or (2) soliciting or receiving remuneration in return for the
referral of federal healthcare program business. Knowingly presenting or
causing claims to be presented for a service for which payment may not
be made under the Stark law
⩥ Amount of civil monetary penalties. Answer: Range from $10,000-
$50,000 per violation and an assessment of up to 3 times the amount of
the over-payments
⩥ Reverse False Claims section of the False Claims Act. Answer: Final
section that provides liability where a person acts improperly to avoid
paying money owed to the government
QUESTIONS AND ANSWERS 100% CORRECT
GRADED A+
⩥ 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 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
,⩥ Current False Claims Act penalties. Answer: $5,500-$11,000 per
claim
⩥ When does the False Claims Act allow for reduced penalties?.
Answer: 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. Answer: 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. Answer: 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. Answer: 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
⩥ Penalty for violating the Anti-Kickback Law. Answer: Up to $25,000
fine and/or imprisonment of up to 5 years
⩥ Stark Law vs. Anti-Kickback Law. Answer: 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. Answer: 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). Answer: 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. Answer: The Social Security Act
authorizes the HHS to seek civil monetary penalties and exclusion for
certain behaviors. These penalties are enforced by the OIG through the
Civil Monetary Penalties (CMP) Law. The severity of penalties and
monetary amounts charged depend on the type of conduct engaged in by
the physician. A physician can incur a CMP in the following ways:
Presenting or causing claims to be presented to a federal healthcare
program that the person knows or should know is for an item or service
that was not provided as claimed or is false or fraudulent.Violating the
Anti-Kickback Statute by knowingly and willfully (1) offering or paying
remuneration to induce the referral of federal healthcare program
business, or (2) soliciting or receiving remuneration in return for the
referral of federal healthcare program business. Knowingly presenting or
causing claims to be presented for a service for which payment may not
be made under the Stark law
⩥ Amount of civil monetary penalties. Answer: Range from $10,000-
$50,000 per violation and an assessment of up to 3 times the amount of
the over-payments
⩥ Reverse False Claims section of the False Claims Act. Answer: Final
section that provides liability where a person acts improperly to avoid
paying money owed to the government
