Fraud, Waste, and Abuse (FWA) 2 Practice Exam

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• Which term refers to the unit within an organization that investigates suspected fraud, waste, and abuse?
• Section 1557 is a provision within which law?
• Bribes or kickbacks of any kind for services that are paid under a Federal health care program constitute fraud by the person making as well as the person receiving them.
• What is waste in health care, in the context of fraud, waste, and abuse?
• Can fraudulent activity be unintentional?
• In addressing fraud concerns, which action is described as removing yourself from the problematic relationship?
• When a corrective action plan is started, are the corrective actions required to be monitored annually to ensure effectiveness?
• Ways to report potential Fraud, Waste, and Abuse (FWA) include:
• You can help prevent Fraud, Waste, and Abuse (FWA) by doing all of the following.
• Which scenario best represents Waste?
• Bribes or kickbacks for services paid under a Federal health care program constitute fraud by
• Which term refers to a network of individuals who identify Medicare underpayments and overpayments?
• Which of the following is NOT one of the seven core elements of a compliance program?
• What term means fake?
• Under ACA Section 1557, which items are included in sex discrimination?
• Under the False Claims Act, penalties can be assessed per claim up to what amount, plus additional damages?
• Which of the following issues should be reported to a Compliance Department?
• Under ACA Section 1557, prohibited actions involve
• ACA Section 1557 provides broader protection against discrimination based on which characteristic?
• Which of the following are examples of issues that can be reported to the Compliance Department?
• Disability protections under ACA Section 1557 address which areas?
• Under ACA Section 1557, a health plan cannot deny coverage to LEP individuals and is required to provide language assistance to them, free of charge.
• Which of the following is an example of an unethical practice that could be reported to Compliance?
• Is it permissible to bill for services provided by an aide?
• Which Medicare programs are covered by ACA Section 1557?
• Which of the following are valid reporting channels?
• Waste includes misuse of resources such as the overuse of services which directly or indirectly results in unnecessary costs to the Medicare Program.
• In emergencies involving a person with limited English proficiency, which interpreter option is permissible?
• ACA Section 1557 disability rules cover which areas?
• What is a key approach to addressing waste by improving outpatient care?
• Overuse refers to which of the following?
• Which statement about reporting channels is true?
• What term is a list of prescription medications that a drug plan will pay for?
• Which term describes the action of charging a Medicare beneficiary more than the reimbursement rate?
• You can help prevent Fraud, Waste, and Abuse (FWA) by doing all of the following.
• FWA can be reported for issues involving which individuals?
• Which of the following are consequences for non-compliance, fraudulent, or unethical behavior?
• What may result from violating Section 1557 nondiscrimination protections?
• Which law says it is illegal to submit false claims or use false records to obtain payment from Medicare or Medicaid?
• The 'commentary reward' in whistleblower protection is contingent upon which event?
• Your supervisor asks you to ignore Sponsor's process and to adjust/add risk diagnosis codes for certain individuals. What should you do?
• In the context of health care waste, what does 'waste' primarily involve regarding testing and procedures?
• Under Section 1557, discrimination is prohibited based on which characteristic?
• A health plan sold through a state exchange may, based on age, do what?
• Which of the following are examples of issues that should be reported to a Compliance Department?
• Medicare Parts C and D plan Sponsors are not required to have a compliance program.
• Is ongoing monitoring of corrective actions necessary after addressing non-compliance or Fraud, Waste, and Abuse (FWA)?
• Which description captures waste related to diagnostic testing that does not affect patient treatment?
• Are Medicare Parts C and D plan Sponsors required to have a compliance program?
• Which term refers to equipment designed for home health care that is durable for repeated medical use?
• Failing to provide language assistance to LEP individuals violates which provision?
• What is the effect of an exclusion from federal health care programs?
• What is the process used when a party disagrees with a decision to deny or stop payment for health care items or services?
• Which of the following describes Civil Monetary Penalty Law regarding waiving coinsurance or deductibles?
• Under the exclusion statute, which statement is true?
• Which of the following are valid channels for reporting potential Fraud, Waste, and Abuse (FWA)?
• Which billing practice involves separating out services or procedures and billing for them individually when they were collectively performed or obtained by a single piece of equipment or as components of a single procedure?
• Which term refers to the list of prescription medications that a drug plan will pay for?
• What is a formal allegation against a party?
• What statement best defines Fraud?
• What is a request for payment for items and services filed under the Medicare program?
• Coordination with other payers is a recommended practice to prevent FWA.
• Waste includes overuse of services and other practices that lead to unnecessary costs.
• Under the exclusion statute, whose billing is prohibited for the services of an excluded provider?
• Under the False Claims Act, penalties can be up to $22,000 per claim plus 3x the government's damages.
• Hospital admission for uncontrolled chronic diseases is cited as waste; which condition is given as an example?
• Knowingly submitting false claims to the Government results in liability for five times the Government's damages plus a penalty. true or false?
• ACA Section 1557 differs from earlier legislation by providing broader protection against discrimination based on
• Which term is the formal mechanism to challenge a denial or stoppage of payment for health care services?
• Complete the sentence: Correcting non-compliance ______________.
• What is the practice of charging a Medicare beneficiary an amount in excess of the Medicare reimbursement rate for Medicare-covered services?
• Regarding potential overpayments, what action is recommended?
• Who is responsible for compliance within an organization?
• What is the overall aim of addressing fraud, waste, and abuse in health care resources and services as described?
• If you suspect fraud, waste, or abuse, you should report it to the Compliance Department.
• Standards of Conduct are the same for every Medicare Parts C and D Sponsor.
• When you suspect illegal activity, which action should you take first?
• Which statement best describes waste in the Medicare context?
• Once a corrective action plan is started, the corrective actions must be monitored annually to ensure they are effective.
• Waste includes any misuse of resources such as the overuse of services, or other practices that, directly or indirectly result in unnecessary costs to the Medicare Program.
• Under ACA Section 1557, prohibited actions involve which areas?
• Which statement best defines Abuse?
• Which practice illustrates waste by favoring costly procedures when cheaper alternatives would suffice?
• Which term means the act of deceiving or misrepresenting?
• Which statement describes the Physician Self-Referral Law?
• What remedy could an individual pursue if they experience a nondiscrimination violation by a health plan under ACA Section 1557?
• Which item is NOT listed as a core component of an effective compliance program?
• Which term describes a person or entity that sells or distributes goods or services?
• Which term is the Health Insurance Portability and Accountability Act (HIPPA)?
• Data accuracy in billing helps prevent Fraud, Waste, and Abuse.
• For a health plan, which are possible consequences of violating ACA Section 1557 nondiscrimination protections?
• Once a corrective action plan is started, should corrective actions be monitored annually to ensure they are effective?
• Which term describes technologically oriented resources that optimize information management?
• What best describes misuse in health care?
• Compliance is the responsibility of the Compliance Officer, Compliance Committee, and Upper Management only.
• Under Section 1557, nondiscrimination protections cover discrimination based on which factors?
• Fraud is defined as what?
• Which health plan types are explicitly mentioned as covered by Section 1557 protections?
• Which of the following is an example of fraud by health care providers?
• Which statement best describes the appropriate steps to take after discovering fraud?
• As a result of violations of ACA Section 1557 nondiscrimination rules, a health plan may revoke an agent or broker's appointment with the health plan.
• Which element is required to prove Fraud?
• Once a corrective action plan begins addressing non-compliance, ongoing monitoring is not necessary.
• Section 1557 applies to all health programs and activities administered by or receiving federal financial assistance from which department?
• Which statement defines Waste?
• Which factor is included in sex discrimination under ACA Section 1557?
• Which statement best defines defensive medicine as described in the material?
• Which item is not part of the whistleblower protection described?
• When a provider's claim submissions appear unusually high relative to peers, what is the proper course of action?
• Which term means the return of a part of the sum received for services because of a prior agreement or coercion?
• Which statement about Exclusion from federal health care programs is true?
• What is the policy of non-retaliation?
• Which of the following statements about Section 1557 nondiscrimination protections is true?
• Bribes or kickbacks for services paid under a Federal health care program constitute fraud by the person making them and by the person receiving them.
• Under typical rules for gifts to patients, which of the following is allowed?
• Which term describes technological resources, devices, and methods that optimize the acquisition, storage, indexing, retrieval, and use of information and data?
• You notice a diagnostic provider submitted a large number of claims for a particular procedure, much higher than other providers. What should you do?
• Which end-of-life care is specifically described as wasteful in the material?
• Underuse occurs when which of the following happens?
• If you suspect fraud and the facility's compliance officer does not respond adequately, which step is appropriate?
• Keeping up to date with FWA policies and procedures, standards of conduct, laws, regulations, and CMS guidance is recommended.
• If you suspect forgery on a prescription, what is the appropriate step?
• Any person who knowingly submits false claims to the Government is liable for five times the Government's damages caused by the violator plus a penalty.
• Section 1557 applies to
• What does the False Claims Act prohibit regarding 'knowing' submission?
• Which program is described as a network of individuals who identify Medicare underpayments and overpayments?
• Which term describes the entity that transmits health information electronically in HIPAA transactions?
• Waste includes any misuse of resources such as the overuse of services, or other practices that, directly or indirectly, result in unnecessary costs to the Medicare Program.
• Ways to report a compliance issue include: All of the above.
• For the person filing the fraud report, what should they do for themselves?
• Which approach is suggested to minimize hospitalizations in chronic diseases?
• What should be included when correcting non-compliance?
• Standards of Conduct are the same for every Medicare Parts C and D Sponsor.
• Which statement accurately describes Exclusion Authorities?
• Under the False Claims Act, is a violator liable for five times the Government's damages plus a penalty?
• Which of the following is a recommended first step if you suspect fraud or abuse?
• Under ACA Section 1557, a person cannot be discriminated against based on what?
• Which organization is a resource for fraud, abuse, and waste concerns in health care?
• Which of the following is a reporting channel commonly used for suspected FWA?
• Under ACA Section 1557, what must health plans provide to individuals with limited English proficiency at no charge?
• What is the act of preventing disclosure or recognition of information?
• Which statement best distinguishes Fraud from Abuse?
• Bribes or kickbacks for services paid under a Federal health care program constitute fraud by whom?
• Abuse is defined as what kind of payer billing?
• Which action is most likely to be permitted in dealing with a person with limited English proficiency?
• Is it permissible for a physical therapist to collect out-of-pocket payment from a Medicare beneficiary for a service not covered by Medicare?
• The policy of non-retaliation protects employees who report suspected non-compliance in good faith.
• As a result of violations of ACA Section 1557 nondiscrimination rules, which action may a health plan take regarding an agent or broker?
• What are some of the penalties for violating Fraud, Waste, and Abuse (FWA) laws?
• At a minimum, an effective compliance program includes four core requirements.
• What are some of the consequences for non-compliance, fraudulent, or unethical behavior?
• Which federal office handles fraud, waste, and abuse in health care programs?
• Which term refers to an individual who monitors and analyzes information to help identify potential fraud and works with law enforcement, prescription drug plans, consumer groups, and others to protect consumers?
• Which of the following is NOT a recommended action to prevent FWA?
• Under ACA Section 1557, sex discrimination includes a person's
• Stark Laws prohibit physicians from referring Medicare/Medicaid patients for designated health services to entities in which the physician has what, unless an exception applies?
• Which of the following are reportable issues to Compliance Department?
• According to the material, what outpatient improvement could minimize hospitalizations related to chronic disease?
• Which statement about the 'knowing' standard under the False Claims Act is true?
• A person comes to your pharmacy to drop off a prescription for a beneficiary who is a regular customer. The prescription is for a controlled substance with a quantity of 160, higher than the usual 60. You review the prescription and have concerns about possible forgery. What is your next step?
• Whistleblowers under the False Claims Act may receive what incentive?
• Which statement best describes the role of standards of conduct in Medicare Parts C and D sponsor operations?
• Which area is not generally covered by ACA Section 1557 nondiscrimination protections?
• Abuse involves payment for items or services when there is no legal entitlement to that payment and the provider has not knowingly and/or intentionally misrepresented facts to obtain payment.
• Which federal agency administers the Medicare program and Medicaid programs and oversees the MACs involved in processing and reviewing Medicare claims at the first and second level of appeals?
• If a health plan violates ACA Section 1557 nondiscrimination protections, which of the following is a possible outcome?
• Which term describes the billing practice that results in higher charges by billing for separate items that were part of a single procedure?
• Some of the laws governing Medicare Parts C and D Fraud, Waste, and Abuse (FWA) include HIPAA; the False Claims Act; the Anti-Kickback Statute; LEIE; and the Health Care Fraud Statute.
• Which reporting channel explicitly involves in-person reporting to a supervisor?
• What term describes a health plan, a health care clearinghouse, or a health care provider that transmits any health information in electronic form in connection with a HIPAA transaction?
• Which entity should be alerted when potential FWA is suspected?
• Which statement best describes the scope of ACA Section 1557 nondiscrimination protections?
• Under ACA Section 1557, which basis cannot be used to discriminate against a person?
• FWA stands for Fraud, Waste, and Abuse.
• Who may sue for nondiscrimination violations under Section 1557?
• Which of the following statements about monitoring corrective actions is true?
• Which of the following is NOT a potential penalty for violations of laws prohibiting Fraud, Waste, and Abuse (FWA)?
• These are examples of issues that should be reported to a Compliance Department: suspected Fraud, Waste, and Abuse (FWA); potential health privacy violation, and unethical behavior/employee misconduct.
• Which statement about Stark Laws is correct?
• Antitrust laws are described as which of the following?
• Which of the following are valid channels for reporting a compliance issue?
• What are possible consequences of violations of ACA Section 1557 for a health plan?
• What is the role of language assistance under ACA Section 1557?
• What does the policy of non-retaliation protect?
• Which statement best describes fraud?
• Which term refers to the law Public Law 104-191 that includes regulations for the use and disclosure of health information and also allows people to qualify immediately for comparable health insurance coverage when they change employment?
• Under whistleblower protection, the government recovers funds, what reward is described?
• Which of the following is NOT a stated element of reporting FWA?
• Which term best describes devices that serve a medical purpose, can withstand repeated use, and are appropriate for use in home health care?
• Which scenario best represents overuse?
• Which of the following is an example of Waste?
• Which statement is most accurate about responsibility for compliance?
• During a routine inventory of controlled substances, you discover a minor discrepancy. What should you do?
• Which statement best describes the core requirements of an effective compliance program?
• Abuse involves payment for items or services when there is no legal entitlement to that payment and the provider has not knowingly and/or intentionally misrepresented facts to obtain payment.
• Which statement describes the Federal Anti-Kickback Statute?
• Which is a feature of a compliance program?
• Underuse refers to which situation?
• Penalties for violating Fraud, Waste, and Abuse laws can include civil penalties, criminal penalties, and exclusion from programs.
• What is one expected outcome of correcting non-compliance?
• What is a common issue with durable medical equipment (DME) in fraud schemes?
• Which practice involves billing for higher service or item codes than those actually performed?
• Stark Laws aim to prevent what?
• Which statement best defines Waste?
• When reporting fraud to the HHS Office of Inspector General, which information should be included?
• Which statement is NOT typically a concern addressed by a compliance program?
• Which of the following are examples of issues that should be reported to a Compliance Department?
• Which of the following is explicitly prohibited as a gift to Medicare beneficiaries?
• Which example describes wasteful end-of-life care as stated?
• Medicare Parts C and D Sponsors are not required to have a compliance program.
• What does the Anti-Kickback Statute prohibit?
• Who is a whistle blower in health care fraud contexts?
• Which of the following is included among laws governing Medicare Parts C and D Fraud, Waste, and Abuse?
• Which term is sometimes abbreviated CMS and refers to the federal agency that administers Medicare and Medicaid programs?
• Which Medicare programs are covered by ACA Section 1557?
• Which scenario would likely trigger enforcement actions under ACA Section 1557?
• Which option is NOT described as a wasteful outcome in the material?
• Correcting non-compliance should focus on which?
• What is the aggregate annual value limit for gifts to a patient?
• Which description best defines a whistle blower in health care reporting?
• What term describes the practice of requesting care from multiple providers, often simultaneously, without coordinating care or informing the providers of the multiple caregivers?
• In the context of corrective action, which option is correct?
• Ways to report potential Fraud, Waste, and Abuse (FWA) include: All of the above.