Combating Medicare Parts C&D Fraud, Waste & Abuse

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

Answer explanation

False

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

Answer explanation

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.

Answer explanation

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.

Answer explanation

True

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.

Answer explanation

True

Waste includes any misuse of resources such as the overuse of services, or other practices that, directly or indirectly, result in unnecessary cost to the medicare program.

Answer explanation

True

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.

Answer explanation

True

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.

Answer explanation

True

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/billing Ensure you coordinate with other payers Keep up to date with FWA policies and procedures, standards of conduct, laws, regulations, and the center for medicare & medicare services (CMS) guidance Verify all information provided to you

Answer explanation

True

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

Answer explanation

All of the above