AAPC CPB - Chapter 1 Terminology | UPDATED Questions with 100% Correct
Answers
Abuse - An action that results in unnecessary costs to a federal healthcare program,
either directly or indirectly
Anti-Kickback - Knowingly and willfully offering or accepting rewards or remuneration for
services that are billable to a federal healthcare plan
Beneficiary - An individual that is eligible for Medicare or Medicaid benefits based on
CMS guidelines
Conditions of Participation (CoP) - Conditions that healthcare organization must meet in
order to participate with the plan or program
Covered Entity - According to HIPAA, defined as health plans, healthcare clearinghouses,
and healthcare providers who electronically transmit any health information in connection with
transactions for which HHS has adopted standards
Criminal Healthcare Fraud Act - Scheme to willingly defraud any healthcare benefit
program
False Claims Act - Federal statute setting criminal and civil penalties for falsely billing the
government, over-representing the amount of a delivered product, or under-stating an
obligation to the government
Fraud - Making false statements or misrepresenting facts to obtain an undeserved
benefit or payment from a federal healthcare program
Answers
Abuse - An action that results in unnecessary costs to a federal healthcare program,
either directly or indirectly
Anti-Kickback - Knowingly and willfully offering or accepting rewards or remuneration for
services that are billable to a federal healthcare plan
Beneficiary - An individual that is eligible for Medicare or Medicaid benefits based on
CMS guidelines
Conditions of Participation (CoP) - Conditions that healthcare organization must meet in
order to participate with the plan or program
Covered Entity - According to HIPAA, defined as health plans, healthcare clearinghouses,
and healthcare providers who electronically transmit any health information in connection with
transactions for which HHS has adopted standards
Criminal Healthcare Fraud Act - Scheme to willingly defraud any healthcare benefit
program
False Claims Act - Federal statute setting criminal and civil penalties for falsely billing the
government, over-representing the amount of a delivered product, or under-stating an
obligation to the government
Fraud - Making false statements or misrepresenting facts to obtain an undeserved
benefit or payment from a federal healthcare program
