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

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 contro...

UNITED HEALTHCARE (UHC) – ETHICS AND COMPLIANCE LATEST 2023-2024 EXAM| ACTUAL QUESTIONS AND VERIFIED ANSWERS |A+ GRADE Q: Agent Jacob learns that Emily, the consumer with whom he is meeting, is the authorized legal representative for her father. What must Jacob explain to Emily when completing an Enrollment Application for her father? Answer: Jacob must explain that Emily will sign the Enrollment Application and must be able to provide documentation upon request by the Plan that indic...

Compliance is the responsibility of the Compliance Officer, Compliance Committee, and Upper Management only. - False Ways to report a compliance issue include: a. Telephone hotlines b. Report on the Sponsor's website c. In-person reporting to the compliance department/supervisor d. All of the above - d. All of the above What is the policy of non-retaliation? a. Allows the Sponsor to discipline employees who violate the Code of Conduct b. Prohibits management and supervisor from harassi...

AHIP TRAINING Medicare Fraud, Waste, and Abuse Training EXAM 50+ QUESTIONS AND VERIFIED CORRECT ANSWERS 2023. AHIP TRAINING Medicare Fraud, Waste, and Abuse Training 1. Medicare plan means: A MA plan, MA-PD plan or PDP 2. Subcontractor means: **An individual or entity that provides services on behalf of a Medicare plan sponsor. This includes individuals and organizations with DIRECT relationship with the plan sponsor or individuals or organizations with INDIRECT relationship, such as ...

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...

Fraud, Waste, Abuse FWA - 2, Fraud Waste and Abuse, Preventing Fraud, Abuse & Waste, Fraud, Abuse, and Waste, Fraud Waste and Abuse 2018 AHIP, fraud, waste, and abuse prevention. Top Questions and answers, 100% Accurate. e - -Ways to report potential Fraud, Waste, and Abuse (FWA) include: a. Telephone hotlines b. Mail Drops c. In-person reporting to the compliance department/supervisor d. Special Investigations Units (SIUs) e. All of the above false - -Once a correctiv...

True or False: The ACA requires that all providers adopt a compliance plan as a condition of enrollment with Medicare, Medicaid, and Children's Health Insurance Program (CHIP). - Answer- True ref. ACA section 6102 According to HHS-OIG - what are three important reasons for proper documentation in Compliance? (hint: protections) - Answer- 1.Protect our programs 2.Protect your patients 3.Protect the Provider At which level of the Medicare Part A or Part B appeals process is the app...

AHIP 2025 Exam Prep| Qs & As| 100% Correct| Grade A (Verified Answers) Q: At a minimum, an effective compliance program includes four core requirements. Answer: False Q: What are some of the consequences for non-compliance, fraudulent, or unethical behavior? Answer: All of the above Q: Correcting non-compliance________. Answer: Protects enrollees, avoids recurrence of same non-compliance, and promotes efficiency Q: What is the policy of non-retaliation...

AHIP FWA 2024 REAL EXAM WITH 150 QUESTIONS AND CORRECT ANSWERS (100% CORRECT VERIFIED ANSWERS) 2024 AHIP FRAUD, WASTE AND ABUSE EXAM BRAND NEW!! Mrs. Shields is covered by Original Medicare. She sustained a hip fracture and is being successfully treated for that condition. However, she and her physicians feel that after her lengthy hospital stay she will need a month or two of nursing and rehabilitative care. What should you tell them about Original Medicare's coverage of care in a...