Health care fraud statute - Study guides, Class notes & Summaries

An Example of Health Plan Employee abuse - Maria Adams works for a Medicare plan. She uses the plan's email to send out information to enrollees of the plan promoting her husband's sports memorabilia business. (This activity would also be in violation of HIPPA privacy rules) AUDIT - **A methodical examination and review of data or processes with the purpose of verifying the data's accuracy or whether established processes are in place or are properly followed. Civil Monetary Penalties - ...

AAPC CPB Chapter 1-5Eight standard transactions were adopted for Electronic Data Interchange (EDI) under HIPAA. Which of the following is NOT included as a standard transaction? a. Payment and remittance advice b. Eligibility in a health plan c. Coordination of benefits d. Physician unique identifier number - correct answer d. Physician unique identifier number A physician received office space at a reduced rate for referring patients to the hospital's out- patient physical therapy ce...

Center for Medicare and Medicaid Services (CMS) CORRECT ANSWER The Centers for Medicare & Medicaid Services, is a federal agency within the United States Department of Health and Human Services that administers the Medicare program and works in partnership with state governments to administer Medicaid, the Children's Health Insurance Program, and health insurance portability standards. Waste CORRECT ANSWER Incurring unnecessary costs as a result of deficient management, practices, or control...

NCCT Practice Test Exam Questions and Answers Latest (100% Solved) Which of the following is an appropriate way to open the discussion when explaining practice fees to a patient? a. "Do you have any questions about the cost of today's visit?" b. We can accept your insurance as payment in full." c. "Do you know what your out of pocket cost is today?" d. "We will bill you for the visit in full." - A. "Do you have any questions about the cost of today's visit?" Which of the follo...

CHC (2023/ 2024) Exam V2 |150 Questions and Verified Answers| 100% Correct Q: Why is Caremark International Derivative Litigation important in Corporate Compliance? Answer: The 1996 U.S. Civil settlement of Caremark International, Inc. Decision established Corporate directors breached their oversight duty by failing to adequately supervise their employees when they knew/should've known a violation of law was occurring. Ref: 698 A.2d 959 (Del. Ch. 1996). Org entered into a 5-year impose...

NCCT REVIEW LAW AND ETHICS EXAM QUESTIONS AND ANSWERS 1. Which of the following activities is an example of abuse rather than fraud? A. upcoding B. misrepresenting the diagnosis C. inadvertent coding errors D. billing for services not rendered - Answer-inadvertent coding errors Rationale Abuse is an unintentional mistake. Fraud is an intentional misrepresentation for gain. Upcoding, misrepresenting the diagnosis, and billing for services not rendered are examples of fraud. Inadvertent ...

NCCT Practice Test Exam Questions and Answers Latest 2024/2025 (100% Correct) Which of the following is an appropriate way to open the discussion when explaining practice fees to a patient? a. "Do you have any questions about the cost of today's visit?" b. We can accept your insurance as payment in full." c. "Do you know what your out of pocket cost is today?" d. "We will bill you for the visit in full." - A. "Do you have any questions about the cost of today's visit?" Which of...

ATI LEADERSHIP EXAM QUESTIONS 100% SOLVED WITH COMPLETE SOLUTIONS 1. An employee in a provider's office suspects fraudulent activity. Which of the following actions should the employee take after contacting the Office of Inspector General (OIG) Hotline to report the fraudulent activity? (Select all that apply.) a. Stop filing the suspicious bills and claims. b. Pursue knowledgeable legal counsel. c. Follow up with the OIG to confirm receipt of the report. d. Disengage professionally wi...

12.1% - ANSWER # of improper Medicare Fee-For-Service claim payments, according to Federal Government. FFS - ANSWER Fee-For-Service Prepayment Review - ANSWER Review of claims prior to payment. Prepayment reviews result in an initial determination. Postpayment Review - ANSWER Review of claims after payment. May result in either no change to the initial determination or a revised determination, indicating an underpayment or overpayment. Underpayment - ANSWER A payment a provider recei...

CPB Final Exam A practice agrees to pay $250,000.00 to settle a lawsuit alleging that the practice used x-rays of one patient to justify services on multiple other patients' claims. The office manager brought the civil suit. What type of case is this? - Qui Tam In which of the following circumstances may PHI not be disclosed without the patient's authorization or permission? - An office receives a call from the patient's husband asking for information about his wife's recent office...