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CPMA Compliance and Regulatory Guidelines (Ch 1) Questions and Answers (100% Pass)
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CPMA Compliance and Regulatory Guidelines (Ch 1) Questions and Answers (100% Pass)
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1|Page | © copyright 2024/2025 | Grade A+CPMA Compliance and Regulatory
Guidelines (Ch 1) Questions and
Answers (100% Pass)
Operation Restore Trust (ORT)
✓ * Two year partnership of federal and state agencies working together
to protect the healthcare trust fund through shared intelligence and
coordinated enforcement
✓ * Three agencies involved: The Office of the Inspector General (OIG),
the Health Care Financing Administration (now CMS), and the
Administration on Aging (AoA).
✓ * Program is now called Senior Medicare Patrol (CMP) with the HHS,
CMS, and OIG working together to combat fraud and abuse.
Fraud
Master01 | October, 2024/2025 | Latest update
, 1|Page | © copyright 2024/2025 | Grade A+
✓ * CMS defines as knowingly making false statements or misrepresenting
facts to obtain an undeserved benefit or payment from a federal
health care plan.
✓ * Intentional
✓ * Examples include:
✓ 1) Billing for services and/or supplies that you know were not furnished
or provided.
✓ 2) Altering claim forms and/or receipts to receive a higher payment
amount.
✓ 3) Billing for services at a higher level than provided or necessary.
✓ 4) Misrepresenting the diagnosis to justify payment.
✓ 5) Making referrals for certain designated services that are prohibited.
Abuse
Master01 | October, 2024/2025 | Latest update
, 1|Page | © copyright 2024/2025 | Grade A+
✓ * CMS defines as an action resulting in unnecessary costs to a federal
healthcare program, either directly or indirectly.
✓ * Unnecessary costs
✓ * Examples include:
✓ 1) Misusing codes on a claim.
✓ 2) Charging excessively for services or supplies.
✓ 3) Billing for services that were not medically necessary.
✓ 4) Failure to maintain adequate medical or financial records.
✓ 5) Improper billing practices.
✓ 6) Billing Medicare patients a higher fee schedule than non-Medicare
patients.
Federal False Claims Act (FCA) Part 1
Master01 | October, 2024/2025 | Latest update
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