Qui tam - Study guides, Class notes & Summaries

CPMA Questions with Correct Answers Graded A+ Under CIA, 50 sampling units are reviewed. What is the sample referred as? A. Discovery Sample B. Initial Sample C. Complete Sample D. Selective Sample A. Discovery Sample (used to determine the net financial error rate) Which may result in false claims act violation? A. A provider routinely waives the copay for MCR beneficiaries B. A provider accepts insurance only payments from MCR beneficiaries C. A provider submits claims to MCR for D...

Test Bank for Law and Ethics in the Business Environment 9e 9th Edition by Terry Halbert, Elaine Ingulli. Full Chapters test bank included CHAPTER 1 Law, Ethics, & Business: An Introduction Freedom versus Responsibility: A Duty to Rescue? Yania v. Bigan (Pennsylvania, 1959) Justifying the “No Duty to Rescue” Rule ■ John Stuart Mill, “On Liberty” Radical Change? ■ Steven J. Heyman, “The Duty to Rescue: A Liberal-Communitarian Approach” Podias v. Mairs (New Jersey, 200...

CCEP Certified Compliance and Ethics Professional 101 Exam Questions and Answers Latest (2024 / 2025) (Verified Answers by Expert) compliance program ANS prevention, detection, collaboration, and enforcement 2. Effective compliance program ANS must be an ongoing process and commitmentto an ethical way of conducting business 3. Office of Inspector General and Justice Department ANS is responsible for enforc-ing the rules and regulations under the Medicare and Medicaid laws outline as partof...

_______ means the provision, coordination, or management of health care and related services by one or more health care providers, including the coordination or management of health care by a health care provider with a third party; consultation between health care providers relating to a patient; or the referral of a patient for health care from one health care provider to another - Treatment "...it cannot be emphasized enough that the only thing worse than not having a policy is having a ...

What does the acronym PHI stand for? a. Patient Healthcare Information b. Patient History of Illness c. Protected Health Information d. Protected Healthcare Index - Answer- c. Protected Health Information A new radiology company opens in town. The manager calls your practice and offers to pay $20 for every Medicare patient you send to them for radiology services. What does this offer violate? a. Stark Laws b. HIPAA c. Anti-Kickback law d. Qui Tam - Answer- c. Anti-Kickback law ...

CHC Auditing & Monitoring (1) Questions and Answers 100% Correct True or False: Risk Management aligns with Quality Management in determining measures for risk avoidance and prevention TRUE Your organization recently completed a contemporaneous audit of laboratory billing practices and found that copays have been written off. Which of the following should be your next step? a. Talk to the billing department to see why this is happening b. Conduct a retrospective audit to see if this occu...

CHC Auditing & Monitoring (1) Questions and Answers 100% Solved True or False: Risk Management aligns with Quality Management in determining measures for risk avoidance and prevention TRUE Your organization recently completed a contemporaneous audit of laboratory billing practices and found that copays have been written off. Which of the following should be your next step? Talk to the billing department to see why this is happening Conduct a retrospective audit to see if this occurr...

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? Answer Qui Tam In which of the following circumstances may PHI not be disclosed without the patient's authorization or permission? Answer An office receives a call from the patient's husband asking for information about his wife's recent office visit. A...

CMS Fraud Definition - correct answer Making false statements or misrepresenting facts to obtain an undeserved benefit or payment from a federal healthcare program CMS Abuse Definition - correct answer An action that results in unnecessary costs to a federal healthcare program, either directly or indirectly CMS Examples of Fraud - correct answer Billing for services and/or supplies that you know were not furnished or provided, altering claim forms and/or receipts to receive a higher ...

CMS Fraud Definition - Answer- Making false statements or misrepresenting facts to obtain an undeserved benefit or payment from a federal healthcare program CMS Abuse Definition - Answer- An action that results in unnecessary costs to a federal healthcare program, either directly or indirectly CMS Examples of Fraud - Answer- Billing for services and/or supplies that you know were not furnished or provided, altering claim forms and/or receipts to receive a higher payment amount, billing a M...