Internal Controls & Fraud Prevention Flashcards

Which internal control activity ensures that recorded financial transactions are supported by appropriate source documents?

Answer: Documentation and record-keeping controls

Documentation controls require source documents (orders, contracts, invoices) to support every transaction entered into the accounting system.

The 'tone at the top' concept in healthcare compliance primarily refers to:

Answer: Senior leadership's visible commitment to ethical conduct and compliance

Tone at the top reflects how senior leadership models and enforces ethical behavior, which cascades throughout the organization.

A Compliance Effective Date (CED) in an OIG Corporate Integrity Agreement (CIA) marks:

Answer: The date the CIA obligations formally begin, typically the settlement effective date

The CED is the official start date of CIA obligations, from which all reporting timelines and annual review periods are measured.

Which fraud triangle element is present when a healthcare billing manager justifies theft by believing the organization 'overcharges patients anyway'?

Answer: Rationalization

Rationalization is the mental justification a fraudster uses to excuse dishonest behavior as acceptable or deserved.

An internal auditor uses data analytics to flag all claims where the date of service falls on a Sunday for a provider with no weekend hours. This technique is best described as:

Answer: Exception reporting

Exception reporting uses predefined rules to flag records that deviate from expected patterns, here identifying impossible service dates.

Which safeguard specifically addresses the risk that a single IT administrator could both create and approve system access for new employees?

Answer: Segregation of duties in user access provisioning

Segregating the roles of requesting, approving, and provisioning user access prevents any one person from granting themselves or others unauthorized system privileges.

Under the OIG's compliance program guidance, which element is described as the 'eyes and ears' of the compliance program?

Answer: Compliance hotline and non-retaliation policy

An accessible, confidential reporting mechanism with non-retaliation protections allows employees to surface concerns and is considered essential for early detection.