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Fraud, Waste, and Abuse Exam Study Guide with Complete Solutions
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Fraud, Waste, and Abuse Exam Study Guide with Complete Solutions
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©PREP4EXAMS@2024/2025 REAL EXAM DUMPS Monday@ August 5@ 2024 6@07 PMFraud, Waste, and Abuse Exam Study
Guide with Complete Solutions
Definition: Knowingly and willfully executing, or attempting to execute:
-a scheme or artifice to defraud any health care benefit program; or
-to obtain, by means of false or fraudulent pretenses, representations, or
-promises, any of the money or property owned by, or under the custody or control
of, any health care benefit program. - ✔️✔️fraud
Definition: overutilization of services, or other practices that, directly or indirectly,
result in unnecessary costs to the Medicare Program. - ✔️✔️waste
T/F: Waste is NOT considered to be cause by criminally negligent actions but
rather misuse of resources - ✔️✔️t
Definition: includes actions that may, directly or indirectly, result in unnecessary
cost to the Medicare program - ✔️✔️abuse
, ©PREP4EXAMS@2024/2025 REAL EXAM DUMPS Monday@ August 5@ 2024 6@07 PM
Definition: Involves payment for items or services when there is not legal
entitlement to that payment and the provider has not knowingly and
or/intentionally misrepresented facts to obtain payment.
-Misusing codes on a claim
-Charging excessively for services - ✔️✔️abuse
The ___ provision of the FCA allows the person pursuing the action to share in any
money reward - ✔️✔️qui tam
Definition: A type of lawsuit that allows a private person, or "relator," to prosecute
a lawsuit for the government and receive a reward - ✔️✔️qui tam
ACT: Primarily used as a tool for combating health care fraud and abuse, most
notably, Medicare and Medicaid billing fraud. - ✔️✔️federal false claims act, licoln
law, false claims act
ACT: Criminal offense to knowingly and willfully offer, pay , solicit or receive any
remuneration to induce or reward referrals of items or serves reimbursable by a
federal health care program. - ✔️✔️anti-kickback stature, anti kickback stature, anti
kickback
Anti-kickback Stature is under the ______ Act - ✔️✔️ss, social socurity
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