Page 1 of 217
CPMA EXAM NEWEST 2025 ACTUAL EXAM TEST
BANK| CERTIFIED PROFESSIONAL MEDICAL AUDITOR
EXAM REVIEW 2025 WITH 300 REAL EXAM QUESTIONS
AND CORRECT DETAILED ANSWERS (VERIFIED
ANSWERS) ALREADY GRADED A+ (BRAND NEW!!)
CMS Fraud Definition .......ANSWER......Making false statements
or misrepresenting facts to obtain an undeserved benefit or
payment from a federal healthcare program
CMS Abuse Definition .......ANSWER......An action that results in
unnecessary costs to a federal healthcare program, either
directly or indirectly
CMS Examples of Fraud .......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
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for services, billing for services at a higher level than provided or
necessary, misrepresenting the diagnosis to justify payment
CMS Examples of Abuse .......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 .......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 .......ANSWER......$5,500-
$11,000 per claim
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When does the False Claims Act allow for reduced penalties?
.......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 .......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
Stark or Physician Self-Referral Law .......ANSWER......Bans
physicians from referring patients for certain services to entities
in which the physician or an immediate family member has a
direct or indirect financial relationship; bans the entity from
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billing Medicare or Medicaid for the services provided as a
result of the self-referral
Anti-Kickback Law .......ANSWER......Similar to the Stark Law but
imposes more severe penalties; states that whoever knowingly or
willfully solicits or receives any remuneration in return for
referring an individual to a person for the furnishing or
arranging of any item or service for which payment may be
made in whole or in part under a federal healthcare program or
in return for purchasing, leasing, ordering, or arranging for or
recommending purchasing, leasing, or ordering any good,
facility, service, or item for which payment may be made in
whole or in part under a federal healthcare program is guilty of
a felony
Penalty for violating the Anti-Kickback Law .......ANSWER......Up
to $25,000 fine and/or imprisonment of up to 5 years
CPMA EXAM NEWEST 2025 ACTUAL EXAM TEST
BANK| CERTIFIED PROFESSIONAL MEDICAL AUDITOR
EXAM REVIEW 2025 WITH 300 REAL EXAM QUESTIONS
AND CORRECT DETAILED ANSWERS (VERIFIED
ANSWERS) ALREADY GRADED A+ (BRAND NEW!!)
CMS Fraud Definition .......ANSWER......Making false statements
or misrepresenting facts to obtain an undeserved benefit or
payment from a federal healthcare program
CMS Abuse Definition .......ANSWER......An action that results in
unnecessary costs to a federal healthcare program, either
directly or indirectly
CMS Examples of Fraud .......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
,Page 2 of 217
for services, billing for services at a higher level than provided or
necessary, misrepresenting the diagnosis to justify payment
CMS Examples of Abuse .......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 .......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 .......ANSWER......$5,500-
$11,000 per claim
,Page 3 of 217
When does the False Claims Act allow for reduced penalties?
.......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 .......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
Stark or Physician Self-Referral Law .......ANSWER......Bans
physicians from referring patients for certain services to entities
in which the physician or an immediate family member has a
direct or indirect financial relationship; bans the entity from
, Page 4 of 217
billing Medicare or Medicaid for the services provided as a
result of the self-referral
Anti-Kickback Law .......ANSWER......Similar to the Stark Law but
imposes more severe penalties; states that whoever knowingly or
willfully solicits or receives any remuneration in return for
referring an individual to a person for the furnishing or
arranging of any item or service for which payment may be
made in whole or in part under a federal healthcare program or
in return for purchasing, leasing, ordering, or arranging for or
recommending purchasing, leasing, or ordering any good,
facility, service, or item for which payment may be made in
whole or in part under a federal healthcare program is guilty of
a felony
Penalty for violating the Anti-Kickback Law .......ANSWER......Up
to $25,000 fine and/or imprisonment of up to 5 years
