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

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