Fraud, Waste, and Abuse

Once a corrective action plan is started, the corrective actions must be monitored annually to ensure they are effective.

• True

• False

Ways to prevent potential fraud, waste, and abuse (FWA) include:

• Telephone hotlines

• Mail drops

• In-person reporting to the compliance department/supervisor

• Special Investigation Units (SIUs)

• All of the above

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.

• True

• False

These are examples of issues that should be reported to a Compliance Department: suspected fraud, waste, and abuse (FWA); potential health privacy violation; unethical behavior; and employee misconduct.

• True

• False

Bribes or kickbacks of any kind for services that are paid under a Federal health care program (which includes Medicare) constitute fraud by the person making as well as the person receiving them.

• True

• False

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.

• True

• False

Abuse involves payment for items or services when there is no legal entitlement to that payment and the provider has not knowingly or intentionally misrepresented facts to obtain payment.

• True

• False

Some of the laws governing Medicare Parts C and D fraud, waste, and abuse (FWA) include the Health Insurance Portability and Accountability Act (HIPAA), the False Claims Act, the Anti-Kickback Statute, and the Health Care Fraud Statute.

• True

• False

You can help prevent fraud, waste, and abuse (FWA) by doing all of the following: look for suspicious activity; conduct yourself in an ethical manner; ensure accurate and timely data and billing; ensure you coordinate with other payers; verify all information provided to you; and keep up to date with FWA policies and procedures, standards of conduct, laws, regulations, and the Centers for Medicare and Medicaid Services (CMS) guidance.

• True

• False

What are some of the penalties for violating fraud, waste, and abuse (FWA) laws?

• Civil Monetary Penalties

• Imprisonment

• Exclusion from participation in all Federal health care programs

• All of the above