AHIP fraud

Ways to report potential Fraud, Waste, and Abuse (FWA) include: a. Telephone hotlines b. Mail Drops c. In-person reporting to the compliance department/supervisor d. Special Investigations Units (SIUs) e. All of the above e Once a corrective action plan is started, the corrective actions must be monitored annually to ensure they are effective. : True False false Any person who knowingly submits false claims to the Government is liable for five times the Government's damages c...

ACA Section 1557 differs from earlier legislation in providing broader protection against discrimination based on sex Section 1557 of the Affordable Care Act applies to c. all health programs and activities administered by or receiving federal financial assistance from HHS. Correct Which Medicare programs are covered by ACA Section 1557? a. Parts A, C, and D, but not B. Correct Under ACA Section 1557, prohibited actions involve d. eligibility, claims, and marketing. Correct Under...

How to recognize FWA in the Medicare Program Knowledge of the law including the Civil False claims Act, Health Care Fraud Statute, and Criminal Fraud, Anti-Kickback Statute, Stark Statute, Exclusion from all Federal healthcare programs, and the Health Insurance Portability and Accountability Act. Civil False Claims Act Makes a person liable to pay damages to the government if 1. He or she knowingly conspires to commit FWA. 2. Carries out other acts to obtain property from the government ...

Ways to report potential Fraud, Waste, and Abuse (FWA) include: a. Telephone hotlines b. Mail Drops c. In-person reporting to the compliance department/supervisor d. Special Investigations Units (SIUs) e. All of the above e Once a corrective action plan is started, the corrective actions must be monitored annually to ensure they are effective. : True False false Any person who knowingly submits false claims to the Government is liable for five times the Government's damages c...

Under ACA Section 1557, a health plan sold through a state exchange may, based on an individual's age, Limit benefits and services. Under ACA Section 1557, a health plan Cannot deny coverage to LEP individuals and is required to provide language assistance to them, free of charge. ACA Section 1557 rules for disability concern Policies and procedures, physical access, and communication. Which of the following statements best describes Section 1557 of the Affordable Care Act (ACA)? S...

Which of the following requires intent to obtain payment and the knowledge that the actions are wrong? Fraud Which of the following is not potentially a penalty for violation of the law or regulation prohibiting fraud, waste and abuse (fwa)? Deportation A person comes into your pharmacy to drop off a prescription for a beneficiary who is a regular customer. The prescription is for a controlled substance with a quantity of 160. This beneficiary normally receives a quantity of 60, not 16...

Mrs. Turner is comparing her employer's retiree insurance to Original Medicare and would like to know which of the following services Original Medicare will cover if the appropriate criteria are met? What could you tell her? Original Medicare covers ambulance services. Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare Advantage plan. What should you tell him? Mr. Singh can enroll in a stand-alone prescription drug plan and continue to be covered for Part A...

Mrs. Turner is comparing her employer's retiree insurance to Original Medicare and would like to know which of the following services Original Medicare will cover if the appropriate criteria are met? What could you tell her? Original Medicare covers ambulance services. Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare Advantage plan. What should you tell him? Mr. Singh can enroll in a stand-alone prescription drug plan and continue to be covered for Part A...

Which of the following requires intent to obtain payment and the knowledge that the actions are wrong? Fraud Which of the following is NOT potentially a penalty for violation of a law or regulation prohibiting Fraud, Waste, and Abuse (FWA)? Deportation A person comes to your pharmacy to drop off a prescription for a beneficiary who is a "regular" customer. The prescription is for a controlled substance with a quantity of 160. This beneficiary normally receives a quantity of 60, not 1...

Compliance is the responsibility of the compliance officer, compliance committee and upper management only False Ways to report a compliance issue include All of the above What is the policy of non-retaliation Protects employees who, in good faith, report suspected non-compliance These are examples of issues that can be reported to a compliance department :suspected fraud, waste, and abuse; potential health privacy violation and unethical behavior/employee misconduct True Once a ...