What regulation is the penalty for violating the False Claims Act (FCA) increased by? - AN-
SWER The Federal Civil Penalties Inflation Adjustment Act; The statute originally provided
for a civil penalty of not less than $5,000, and not more than $10,000, per claim, plus three
times the amount of the government damages if FCA liability was found. This amount is oc-
casionally increased based on the Federal Civil Penalties Inflation Adjustment Act (FCPIA).
When an IRO is completing a CIA Discovery Sample, how many sampling units are reviewed?
- ANSWER 50
You audit a provider who is consistently reporting multiple units of CPT code 11042. What
references can you use to show the provider multiple units of CPT code 11042 are not al-
lowed and explain how it should be reported? - ANSWER CPT codebook and MUE (Medi-
cal Unlikely Edits) table.
Under a CIA, 50 sampling units are selected for review. What is this sample referred to as? -
ANSWER Discovery Sample; Under a CIA, a Discovery Sample of 50 sampling units is ran-
domly selected for review. This Discovery Sample is used to determine the net financial error
rate
What action would be considered fraud rather than abuse? - ANSWER A provider requir-
ing the coding staff to intentionally code E/M services one level higher than documented.
The OIG Work Plan is divided into seven elements. Which option is a part of the OIG Work
Plan most applicable to physician services? - ANSWER Medicare Part A and Part B
A provider consistently charges a higher level of E/M service than is documented to help
cover the cost of his declining practice. Would this be fraud or abuse, and why? -
1
SWER The Federal Civil Penalties Inflation Adjustment Act; The statute originally provided
for a civil penalty of not less than $5,000, and not more than $10,000, per claim, plus three
times the amount of the government damages if FCA liability was found. This amount is oc-
casionally increased based on the Federal Civil Penalties Inflation Adjustment Act (FCPIA).
When an IRO is completing a CIA Discovery Sample, how many sampling units are reviewed?
- ANSWER 50
You audit a provider who is consistently reporting multiple units of CPT code 11042. What
references can you use to show the provider multiple units of CPT code 11042 are not al-
lowed and explain how it should be reported? - ANSWER CPT codebook and MUE (Medi-
cal Unlikely Edits) table.
Under a CIA, 50 sampling units are selected for review. What is this sample referred to as? -
ANSWER Discovery Sample; Under a CIA, a Discovery Sample of 50 sampling units is ran-
domly selected for review. This Discovery Sample is used to determine the net financial error
rate
What action would be considered fraud rather than abuse? - ANSWER A provider requir-
ing the coding staff to intentionally code E/M services one level higher than documented.
The OIG Work Plan is divided into seven elements. Which option is a part of the OIG Work
Plan most applicable to physician services? - ANSWER Medicare Part A and Part B
A provider consistently charges a higher level of E/M service than is documented to help
cover the cost of his declining practice. Would this be fraud or abuse, and why? -
1
