AHIP Fraud, Waste, and Abuse (FWA) Prevention 2

Question 1

What is 'waste' in the context of Medicare FWA?

Accepted Answer

Overutilization or misuse of resources without intent to defraud

Answer

Intentional overcharging for services

Answer

Billing for services never rendered

Answer

Criminal diversion of Medicare funds

Question 2

A Medicare beneficiary who knowingly lets someone else use their Medicare card commits:

Accepted Answer

Fraud

Answer

Waste

Answer

Abuse

Answer

A billing error

Question 3

What is the OIG Exclusion List?

Accepted Answer

A list of individuals and entities excluded from participating in federal healthcare programs due to misconduct

Answer

A list of fraudulent beneficiaries barred from Medicare

Answer

A CMS list of non-contracted pharmacies

Answer

A state-level registry of abusive billing providers

Question 4

Under HIPAA, individually identifiable health information (PHI) may NOT be disclosed without patient authorization EXCEPT:

Accepted Answer

For treatment, payment, or healthcare operations

Answer

When requested by a marketing company

Answer

To employers for productivity monitoring

Answer

To family members without the patient's knowledge

Question 5

Which of the following is an example of 'abuse' rather than 'fraud'?

Accepted Answer

Routinely scheduling more follow-up visits than medically necessary without intent to defraud

Answer

Billing for services not provided

Answer

Falsifying a diagnosis to justify payment

Answer

Forging patient signatures on medical records

Question 6

What is the purpose of a Medicare Compliance Program for health plans?

Accepted Answer

To prevent, detect, and correct non-compliance with CMS requirements and FWA

Answer

To replace state insurance department oversight

Answer

To manage plan premiums and deductibles

Answer

To handle member grievances exclusively