CPMA Exam Complete Questions And Answers With Latest Quiz

CPMA Exam Complete Questions And Answers With
Latest Quiz

,CPMA Exam Complete Questions And Answers With
Latest Quiz



CMS Fraud Definition - ANS-Making false statements or misrepresenting facts to obtain an
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undeserved benefit or payment from a federal healthcare program
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CMS Abuse Definition - ANS-An action that results in unnecessary costs to a federal
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healthcare program, either directly or indirectly
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CMS Examples of Fraud - ANS-Billing for services and/or supplies that you know were not
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furnished or provided, altering claim forms and/or receipts to receive a higher payment
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amount, billing a Medicare patient above the allowed amount for services, billing for
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services at a higher level than provided or necessary, misrepresenting the diagnosis to
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justify payment
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CMS Examples of Abuse - ANS-Misusing codes on a claim, charging excessively for services
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or supplies, billing for services that were not medically necessary, failure to maintain
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adequate medical or financial records, improper billing practices, billing Medicare
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patients a higher fee schedule than non-Medicare patients
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False Claims Act - ANS-Any person is liable if they knowingly present or cause to be
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presented a false or fraudulent claim for payment or approval; knowingly makes, uses, or
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causes to be made or used, a false record or material to a false or fraudulent claims
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,CPMA Exam Complete Questions And Answers With
Latest Quiz


Current False Claims Act penalties - ANS-$5,500-$11,000 per claim
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When does the False Claims Act allow for reduced penalties? - ANS-If the person
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committing the violation self-discloses and provides all known info within 30 days, fully
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cooperates with the investigation, and there is no criminal prosecution, civil action, or
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administrative action regarding the violation
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Qui Tam or "Whistleblower" provision - ANS-If an individual (known as a "relator") knows
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of a violation of the False Claims Act, he or she may bring a civil action on behalf of him
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or herself and on behalf of the U.S. government; the relator may be awarded 15-25% of
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the dollar amount recovered
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Stark or Physician Self-Referral Law - ANS-Bans physicians from referring patients for
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certain services to entities in which the physician or an immediate family member has a
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direct or indirect financial relationship; bans the entity from billing Medicare or Medicaid
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for the services provided as a result of the self-referral
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Anti-Kickback Law - ANS-Similar to the Stark Law but imposes more severe penalties;
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states that whoever knowingly or willfully solicits or receives any remuneration in return
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for referring an individual to a person for the furnishing or arranging of any item or
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service for which payment may be made in whole or in part under a federal healthcare
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, CPMA Exam Complete Questions And Answers With
Latest Quiz
program or in return for purchasing, leasing, ordering, or arranging for or recommending
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purchasing, leasing, or ordering any good, facility, service, or item for which payment may
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be made in whole or in part under a federal healthcare program is guilty of a felony
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Penalty for violating the Anti-Kickback Law - ANS-Up to $25,000 fine and/or
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imprisonment of up to 5 years
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Stark Law vs. Anti-Kickback Law - ANS-Anti-Kickback applies to anyone, not just
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physicians; the Anti-Kickback Law requires proof of intention and states that the person
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must "knowingly and willfully" violate the law.
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Exclusion Statute - ANS-Under the Exclusion Statute, a physician who is convicted of a
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criminal offense—such as Medicare fraud (both misdemeanor and felony convictions),
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patient abuse and neglect, or illegal distribution of controlled substances—can be banned
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from participating in Medicare by the OIG. Physicians who are excluded may not directly
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or indirectly bill the federal government for the services they provide to Medicare
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patients.
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List of Excluded Individuals/Entities (LEIE) - ANS-Produced and updated by the OIG;
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provides information regarding individuals and entities currently excluded from
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participation in Medicare, Medicaid, and all other federal healthcare programs; sorts
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excluded individuals or entities by the legal basis for the exclusion, the types of
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