CPMA Exam Complete Questions And Answers With Latest Quiz

CPMA Exam Complete Questions And Answers With Latest Quiz 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 payment amount, billing a Medicare patient above the allowed amount for services, billing for services at a higher level than provided or necessary, misrepresenting the diagnosis to justify payment CMS Examples of Abuse Correct Answer: Misusing codes on a claim, charging excessively for services or supplies, billing for services that were not medically necessary, failure to maintain adequate medical or financial records, improper billing practices, billing Medicare patients a higher fee schedule than non-Medicare patients False Claims Act Correct Answer: Any person is liable if they knowingly present or cause to be presented a false or fraudulent claim for payment or approval; knowingly makes, uses, or causes to be made or used, a false record or material to a false or fraudulent claims Current False Claims Act penalties Correct Answer: $5,500-$11,000 per claim When does the False Claims Act allow for reduced penalties? Correct Answer: If the person committing the violation self-discloses and provides all known info within 30 days, fully cooperates with the investigation, and there is no criminal prosecution, civil action, or administrative action regarding the violation Qui Tam or "Whistleblower" provision Correct Answer: If an individual (known as a "relator") knows of a violation of the False Claims Act, he or she may bring a civil action on behalf of him or herself and on behalf of the U.S. government; the relator may be awarded 15-25% of the dollar amount recovered S