CPMA Exam AND PRACTICE EXAM NEWEST 2026/2027 TEST BANK|CERTIFIED PROFESSIONAL MEDICAL AUDITOR EXAM PREP WITH COMPLETE 810 REAL EXAM QUESTIONS AND CORRECT DETAILED ANSWERS (VERIFIED ANSWERS) ALREADY GRADED A+ (BRAND NEW!!)

CPMA Exam AND PRACTICE EXAM
NEWEST 2026/2027 TEST
BANK|CERTIFIED PROFESSIONAL
MEDICAL AUDITOR EXAM PREP WITH
COMPLETE 810 REAL EXAM
QUESTIONS AND CORRECT
DETAILED ANSWERS (VERIFIED
ANSWERS) ALREADY GRADED A+
(BRAND NEW!!)
CMSmFraudmDefinitionm-
mCORRECTmANSWERmMakingmfalsemstatementsmormmisrepresentingmfactsmtomobtainmanmundeserv


edmbenefitmormpaymentmfrommamfederalmhealthcaremprogram



CMSmAbusemDefinitionm-
mCORRECTmANSWERmAnmactionmthatmresultsminmunnecessarymcostsmtomamfederalmhealthcaremprogr


am,meithermdirectlymormindirectly



CMSmExamplesmofmFraudm-
mCORRECTmANSWERmBillingmformservicesmand/ormsuppliesmthatmyoumknowmweremnotmfurnishedmor


mprovided,malteringmclaimmformsmand/ormreceiptsmtomreceivemamhighermpaymentmamount,mbillingma


mMedicarempatientmabovemthemallowedmamountmformservices,mbillingmformservicesmatmamhighermleve


lmthanmprovidedmormnecessary,mmisrepresentingmthemdiagnosismtomjustifympayment



CMSmExamplesmofmAbusem-
mCORRECTmANSWERmMisusingmcodesmonmamclaim,mchargingmexcessivelymformservicesmormsupplies,m


billingmformservicesmthatmweremnotmmedicallymnecessary,mfailuremtommaintainmadequatemmedicalmo
rmfinancialmrecords,mimpropermbillingmpractices,mbillingmMedicarempatientsmamhighermfeemschedule
mthanmnon-Medicarempatients

,FalsemClaimsmActm-
mCORRECTmANSWERmAnympersonmismliablemifmtheymknowinglympresentmormcausemtombempresentedm


amfalsemormfraudulentmclaimmformpaymentmormapproval;mknowinglymmakes,muses,mormcausesmtombem
mademormused,mamfalsemrecordmormmaterialmtomamfalsemormfraudulentmclaims



CurrentmFalsemClaimsmActmpenaltiesm-mCORRECTmANSWERm$5,500-$11,000mpermclaim



WhenmdoesmthemFalsemClaimsmActmallowmformreducedmpenalties?m-
mCORRECTmANSWERmIfmthempersonmcommittingmthemviolationmself-


disclosesmandmprovidesmallmknownminfomwithinm30mdays,mfullymcooperatesmwithmtheminvestigation,m
andmtheremismnomcriminalmprosecution,mcivilmaction,mormadministrativemactionmregardingmthemviola
tion



QuimTammorm"Whistleblower"mprovisionm-
mCORRECTmANSWERmIfmanmindividualm(knownmasmam"relator")mknowsmofmamviolationmofmthemFalsem


ClaimsmAct,mhemormshemmaymbringmamcivilmactionmonmbehalfmofmhimmormherselfmandmonmbehalfmofmt
hemU.S.mgovernment;mthemrelatormmaymbemawardedm15-25%mofmthemdollarmamountmrecovered



StarkmormPhysicianmSelf-ReferralmLawm-
mCORRECTmANSWERmBansmphysiciansmfrommreferringmpatientsmformcertainmservicesmtomentitiesminm


whichmthemphysicianmormanmimmediatemfamilymmembermhasmamdirectmormindirectmfinancialmrelatio
nship;mbansmthementitymfrommbillingmMedicaremormMedicaidmformthemservicesmprovidedmasmamresult
mofmthemself-referral




Anti-KickbackmLawm-
mCORRECTmANSWERmSimilarmtomthemStarkmLawmbutmimposesmmoremseverempenalties;mstatesmthatm


whoevermknowinglymormwillfullymsolicitsmormreceivesmanymremunerationminmreturnmformreferringma
nmindividualmtomampersonmformthemfurnishingmormarrangingmofmanymitemmormservicemformwhichmpay
mentmmaymbemmademinmwholemorminmpartmundermamfederalmhealthcaremprogrammorminmreturnmform
purchasing,mleasing,mordering,mormarrangingmformormrecommendingmpurchasing,mleasing,mormorder
ingmanymgood,mfacility,mservice,mormitemmformwhichmpaymentmmaymbemmademinmwholemorminmpartmu
ndermamfederalmhealthcaremprogrammismguiltymofmamfelony

,PenaltymformviolatingmthemAnti-KickbackmLawm-
mCORRECTmANSWERmUpmtom$25,000mfinemand/ormimprisonmentmofmupmtom5myears




StarkmLawmvs.mAnti-KickbackmLawm-mCORRECTmANSWERmAnti-
Kickbackmappliesmtomanyone,mnotmjustmphysicians;mthemAnti-
KickbackmLawmrequiresmproofmofmintentionmandmstatesmthatmthempersonmmustm"knowinglymandmwil
lfully"mviolatemthemlaw.



ExclusionmStatutem-
mCORRECTmANSWERmUndermthemExclusionmStatute,mamphysicianmwhomismconvictedmofmamcriminalmo


ffense—
suchmasmMedicaremfraudm(bothmmisdemeanormandmfelonymconvictions),mpatientmabusemandmnegle
ct,mormillegalmdistributionmofmcontrolledmsubstances—
canmbembannedmfrommparticipatingminmMedicarembymthemOIG.mPhysiciansmwhomaremexcludedmmaym
notmdirectlymormindirectlymbillmthemfederalmgovernmentmformthemservicesmtheymprovidemtomMedicar
empatients.



ListmofmExcludedmIndividuals/Entitiesm(LEIE)m-
mCORRECTmANSWERmProducedmandmupdatedmbymthemOIG;mprovidesminformationmregardingmindivi


dualsmandmentitiesmcurrentlymexcludedmfrommparticipationminmMedicare,mMedicaid,mandmallmotherm
federalmhealthcaremprograms;msortsmexcludedmindividualsmormentitiesmbymthemlegalmbasismformthem
exclusion,mthemtypesmofmindividualsmandmentitiesmthatmhavembeenmexcluded,mandmthemstatesmwher
emthemexcludedmindividualmresidedmatmthemtimemtheymweremexcludedmormthemstateminmwhichmtheme
ntitymwasmdoingmbusiness



CivilmMonetarymPenaltiesmLawm-
mCORRECTmANSWERmThemSocialmSecuritymActmauthorizesmthemHHSmtomseekmcivilmmonetarympenalti


esmandmexclusionmformcertainmbehaviors.mThesempenaltiesmaremenforcedmbymthemOIGmthroughmthem
CivilmMonetarymPenaltiesm(CMP)mLaw.mThemseveritymofmpenaltiesmandmmonetarymamountsmcharge
dmdependmonmthemtypemofmconductmengagedminmbymthemphysician.mAmphysicianmcanmincurmamCMPmi
nmthemfollowingmways:mPresentingmormcausingmclaimsmtombempresentedmtomamfederalmhealthcarempr
ogrammthatmthempersonmknowsmormshouldmknowmismformanmitemmormservicemthatmwasmnotmprovide
dmasmclaimedmormismfalsemormfraudulent.ViolatingmthemAnti-

, KickbackmStatutembymknowinglymandmwillfullym(1)mofferingmormpayingmremunerationmtominducemthe
mreferralmofmfederalmhealthcaremprogrammbusiness,morm(2)msolicitingmormreceivingmremunerationmin


mreturnmformthemreferralmofmfederalmhealthcaremprogrammbusiness.mKnowinglympresentingmormcausi


ngmclaimsmtombempresentedmformamservicemformwhichmpaymentmmaymnotmbemmademundermthemStar
kmlaw



Amountmofmcivilmmonetarympenaltiesm-mCORRECTmANSWERmRangemfromm$10,000-
$50,000mpermviolationmandmanmassessmentmofmupmtom3mtimesmthemamountmofmthemover-payments



ReversemFalsemClaimsmsectionmofmthemFalsemClaimsmActm-
mCORRECTmANSWERmFinalmsectionmthatmprovidesmliabilitymwheremampersonmactsmimproperlymtomav


oidmpayingmmoneymowedmtomthemgovernment



Examplesmofmfraud/misconductmsubjectmtomthemFalsemClaimsmActm-
mCORRECTmANSWERmFalsifyingmammedicalmchartmnotation;msubmittingmclaimsmformservicesmnotmpe


rformed,mnotmrequested,mormunnecessary;msubmittingmclaimsmformexpiredmdrugs;mupcodingmand/o
rmunbundlingmservices;msubmittingmclaimsmformphysicianmservicesmperformedmbymamnon-
physicianmprovidermwithoutmregardmtomIncident-tomguidelines



ExceptionsmtomthemStarkmLawm-
mCORRECTmANSWERmGeneralmexceptionsmtombothmownershipmandmcompensationmarrangementmp


rohibitionsm(in-
officemancillarymservices);mgeneralmexceptionsmrelatedmonlymtomownershipmorminvestmentmprohibit
ionmformownershipminmpubliclymtradedmsecuritiesmandmmutualmfundsm(servicesmfurnishedmbymamrur
almprovider);mexceptionsmrelatedmtomothermcompensationmarrangementsm(personalmservicesmarran
gementsmandmrentalmofmofficemspacemandmequipment)



OfficemofmthemInspectormGeneralm(OIG)m-
mCORRECTmANSWERmDetectsmandmpreventsmfraud,mwaste,mandmabusemandmimprovesmefficiencymof


mHHSmprograms;mmostmresourcesmaremdirectedmtowardmthemoversightmofmMedicaremandmMedicaid,


mbutmalsomextendmtomthemCentersmformDiseasemControlmandmPreventionm(CDC),mNationalmInstitutes


mofmHealthm(NIH),mandmthemFoodmandmDrugmAdministration m(FDA)