WCC Exam 2 Study Guide Questions with 100% Correct Answers

WCC Exam 2 Study Guide Questions
with 100% Correct Answers
KnowAmajorAreasonsAforAwhyAtheAhealthcareAsystemAisAuniqueAinAtermsAofAWCC.A-
AAnswerAoffendersAareAtrainedAandAtrusted
victimsAdon'tAhaveAknowledge
highlyAself-regualted


BeAfamiliarAwithAfollowingAterms:Afraud,Aabuse,AMedicare,AMedicaidA-AAnswerAmedicare-elderly

medicaid-poor
fraud:AintentionallyAcriminalAbehaviorsAbyAphysicians
abuse:AunintentionalAmisuseAofAprogramAfunds


WhatAisAtheAmostApervasiveAformAofAfraudAinAtheAhealthcareAsystem?A-
AAnswerAmedicare/medicaidAfraud


whatAfactorsAmakeAMedicare/MedicaidAfraudAmoreAlikely?A-
AAnswerAgovernmentAhasAtoApayAoutAwithinA30Adays


HowAdoAphysiciansAengageAinAfraudAandAabuse?A-
AAnswerAphantomAtreatment,AsubstituteAproviders,Aupcoding,AfalsifyingArecords,AunnecessaryAservic
es,Aunbundling,AoverchargingApatients,ApingApongAandAkickbackAschemes,Aganging,Aco-
payAwaivers,AmedicalAsnowballing


KnowAaboutAmedicalAmalpracticeAandAtheAtermAiatrogenicAeventsA-
AAnswerAtheAdistinctionAfromAfraudAtoAmalpracticeAisAharm;AeventsAthatAcauseAmoreAharmAthanA
good


HeAkeptAperformingAangiogramsAonApeopleAthatAdidAnotAneedAitA-
AAnswerAHeAkeptAperformingAangiogramsAonApeopleAthatAdidAnotAneedAit


WhatAareAtheAsocial/culturalAcontextsAthatAmakeAphysicianAfraudAmoreAlikely?A-
AAnswerAVictimAvulnerability-AuncertaintyAisAtheAprimaryAreasonAforAmedicalAconsultations
Patient/publicAdemandAforAtreatment-AdiseaseAfear,AphysicianAtrustA(notAinsurance),AfaithAinAsystem
EconomicAstructureAofAsystem-A"feeAforAservice"AratherAthanAwellnessAoutcomes

, WhatAdidAtheAAl-
JazeeraAdocumentaryAonApharmaceuticalAfraudAsuggestAwasAaAmajorAformAofAunethicalAorAcriminalA
behaviorAundertakenAbyAlargeAdrug-makingAcompanies?A-
AAnswerAprescribingAmedicationAnotAapprovedAforAcertainAdiseases


WhatAareAtheAconsequencesAofAmedicalAmalpractice,AespeciallyAinAtermsAofAunnecessaryAservices?A-
AAnswerAdifficultAtoAgetAgoodAestimatesAbecauseAdataAprimarilyAreliesAonAcivilAtrials
InjuriesAandAdeath
DeprivingAthoseAtrulyAinAneed
WastedAtimeAofApatients


WhyAdoAcrimesAbyAdoctorsAgetAsuchAlittleAattentionAfromAcriminologists,Amedia,AandAgeneralApublic
?A-AAnswerAbecauseAofAtheArespect,Apower,AandAtrustAthatAtheAprofessionAengenders


WhatAisAtheAmostApervasiveAformAofAfraudAcommittedAbyAdoctors?A-
AAnswerAMedicareAandAMedicaidAfraudAandAabuse


WhatAareAsomeA(notAall)AofAtheAmethodsAbyAwhichAdoctorsAmightAengageAinAfraud?A-
AAnswerA1)AphantomAtreatment
-providersAbillAmedicaid,Amedicare,AorAotherAinsuranceAcompaniesAforAservicesAtheyAneverAprovided
2)AsubstituteAproviders
-theAmedicalAservicesAwereAperformedAbyAanAemployeeAwhoAwasAnotAauthorizedAtoAperformAthem
3)AupcodingA(upgrading)
-providersAbillAforAservicesAthatAwereAmoreAexpensiveAthanAtheAservicesAprovided
4)AprovisionAofAunnecessaryAservices
5)AmisrepresentingAservices
-providersAdescribeAservicesArenderedAdifferentlyAinAanAanAattemptAtoAgainApayment
6)AfalsifyingArecords
-AprovidersAchangeAmedicalAformsAtoAbeAreimbursedAbyAinsuranceAprovider
7)AoverchargingApatients
8)Aunbundling
-providerAbillsAseparatelyAforAtests/servicesAthatAwereAsupposedAtoAbeAchargedAasAoneAprocedure
9)Apingponging
-patientsAunnecessarilyAreferredAtoAotherAdoctorsAandAareA"bouncedAaround"
10)Aganging