CCT Healthcare Fraud and Abuse 3

Question 1

What is the 'qui tam' provision of the False Claims Act?

Accepted Answer

A provision allowing private citizens to sue on behalf of the government and share in recoveries

Answer

The qui tam provision allows private individuals (relators) to file sealed lawsuits alleging FCA violations on behalf of the government and receive 15–30% of any recovered proceeds.

Question 2

A home health agency bills Medicare for skilled nursing visits that were never performed. This is an example of:

Accepted Answer

Phantom billing

Answer

Phantom billing (billing for services not rendered) occurs when a provider submits claims for services that were never actually provided to the patient.

Question 3

Under Stark Law, which of the following is a 'designated health service' subject to the physician self-referral prohibition?

Accepted Answer

Clinical laboratory services

Answer

Clinical laboratory services are one of the eleven designated health services (DHS) listed under Stark Law to which the self-referral prohibition applies.

Question 4

What government agency is primarily responsible for investigating healthcare fraud in the Medicare and Medicaid programs?

Accepted Answer

Office of Inspector General (OIG)

Answer

The OIG of HHS is the primary federal agency responsible for detecting and investigating fraud, waste, and abuse in Medicare, Medicaid, and other HHS programs.

Question 5

A provider routinely waives Medicare copayments for all patients without determining financial need. This practice may violate the Anti-Kickback Statute because:

Accepted Answer

Routine waivers can induce patients to select providers based on financial benefit

Answer

Routine waiver of Medicare cost-sharing can constitute illegal remuneration under the AKS by inducing beneficiaries to choose providers based on the financial benefit rather than clinical judgment.

(CCT) Certified Compliance Technician Practice Test

(CCT) Certified Compliance Technician Practice Test

CCT Healthcare Fraud and Abuse 3