CMS Medicare Specialist Fraud, Waste & Abuse Prevention 3

Question 1

What is the primary purpose of the OIG's List of Excluded Individuals and Entities (LEIE)?

Accepted Answer

To list providers who are prohibited from participating in federal healthcare programs

Answer

The LEIE identifies individuals and entities that have been excluded from participation in Medicare, Medicaid, and other federal healthcare programs due to fraud, abuse, or other misconduct.

Question 2

Which of the following scenarios best illustrates a 'kickback' violation under the Anti-Kickback Statute?

Accepted Answer

A durable medical equipment company offering lavish gifts to physicians to prescribe their products to Medicare patients

Answer

Offering gifts or remuneration to physicians to induce prescription of products covered by Medicare is a classic kickback arrangement prohibited by the Anti-Kickback Statute.

Question 3

In Medicare compliance programs, what is the role of a 'compliance officer'?

Accepted Answer

To oversee the organization's compliance program and ensure adherence to Medicare regulations

Answer

A compliance officer is responsible for developing, implementing, and overseeing a comprehensive compliance program to ensure the organization meets Medicare regulatory requirements and identifies potential fraud, waste, and abuse.

Question 4

What is 'phantom billing' in the context of Medicare fraud?

Accepted Answer

Billing Medicare for services or equipment never provided to patients

Answer

Phantom billing is submitting claims to Medicare for services, procedures, or equipment that were never actually provided to the beneficiary.

Question 5

When must an organization report and return an identified Medicare overpayment under the 60-day rule?

Accepted Answer

Within 60 days of identifying the overpayment

Answer

Under the Affordable Care Act's 60-day rule, providers must report and return identified Medicare overpayments within 60 days of identification to avoid False Claims Act liability.

(CMS) Certified Medicare Specialist Practice Test

(CMS) Certified Medicare Specialist Practice Test

CMS Medicare Specialist Fraud, Waste & Abuse Prevention 3