Fraud abuse and waste - Study guides, Class notes & Summaries

WHat's the problem with healthcare fraud and abuse? CORRECT ANSWER $765 billion per year has been lost due to fraud, abuse, and waste. ($75 billion is due to fraud) - overutilization of services and increased costs for payers - corrupts medical decision‐making -can lead to unfair competition in the marketplace - puts patients' health and welfare at risk by potentially exposing them to unnecessary services and ultimately taking money away from necessary care ROI for Health Care Fraud a...

ACA Section 1557 differs from earlier legislation in providing broader protection against discrimination based on CORRECT ANSWER sex Section 1557 of the Affordable Care Act applies to CORRECT ANSWER c. all health programs and activities administered by or receiving federal financial assistance from HHS. Correct Which Medicare programs are covered by ACA Section 1557? CORRECT ANSWER a. Parts A, C, and D, but not B. Correct Under ACA Section 1557, prohibited actions involve CORRECT ANSWER...

Fraud Waste and Abuse | 50 Actual Questions and Answers 100% Correct | New Update 2024

AHIP Fraud Waste and Abuse Questions With Verified Answers Which of the following requires intent to obtain payment and the knowledge that the actions are wrong? - ANSWER Fraud Which of the following is NOT potentially a penalty for violation of a law or regulation prohibiting Fraud, Waste, and Abuse (FWA)? - ANSWER Deportation A person comes to your pharmacy to drop off a prescription for a beneficiary who is a "regular" customer. The prescription is for a controlled substance...

Your job is to submit a risk diagnosis to the Centers for Medicare & Medicaid Services (CMS) for the purpose of payment. As part of this job, you use a process to verify the data is accurate. Your immediate supervisor tells you to ignore the Sponsor's process and to adjust or add risk diagnosis codes for certain individuals. What should you do? Report the incident to the compliance department (via compliance hotline or other mechanism) You are performing a regular inventory of the contr...

AHIP Fraud Waste and Abuse Questions With Verified Answers Which of the following requires intent to obtain payment and the knowledge that the actions are wrong? - ANSWER Fraud Which of the following is NOT potentially a penalty for violation of a law or regulation prohibiting Fraud, Waste, and Abuse (FWA)? - ANSWER Deportation A person comes to your pharmacy to drop off a prescription for a beneficiary who is a "regular" customer. The prescription is for a controlled substance...

ACA Section 1557 differs from earlier legislation in providing broader protection against discrimination based on - CORRECT ANSWER sex Section 1557 of the Affordable Care Act applies to - CORRECT ANSWER c. all health programs and activities administered by or receiving federal financial assistance from HHS. Correct Which Medicare programs are covered by ACA Section 1557? - CORRECT ANSWER a. Parts A, C, and D, but not B. Correct Under ACA Section 1557, prohibited actions i...

UNITED HEALTHCARE (UHC) – ETHICS AND COMPLIANCE LATEST 2023-2024 EXAM| ACTUAL QUESTIONS AND VERIFIED ANSWERS Version 2 |A+ GRADE Q: John has Power of Attorney to act on behalf of his mother. What does that mean when it comes to his mother enrolling in a Medicare Advantage Plan? Answer: John may sign the Enrollment Application and must be able to provide documentation upon request by the Plan that indicates his authority under state law to enroll his mother. Q: In which of the...