HAC Internal Controls & Fraud Prevention 3

Question 1

A physician upcodes a 99213 office visit to a 99215 to increase reimbursement. Under the False Claims Act, this is most accurately classified as:

Accepted Answer

Fraud

Answer

Intentional upcoding to obtain higher reimbursement meets the FCA definition of fraud because it involves a knowing false claim.

Question 2

Which document formally defines the scope, objectives, and approach of an internal audit engagement?

Accepted Answer

Engagement letter

Answer

The engagement letter (or audit plan) formally establishes the scope, objectives, timing, and methodology before fieldwork begins.

Question 3

A radiology technician steals cash co-payments before they are recorded. Which control would most directly prevent this?

Accepted Answer

Mandatory pre-numbered receipt issuance at point of collection

Answer

Pre-numbered receipts issued at the point of collection create an audit trail that makes skimming immediately detectable.

Question 4

Under the Sarbanes-Oxley Act Section 302, which individuals must certify the accuracy of financial reports for publicly traded healthcare entities?

Accepted Answer

Chief Executive Officer and Chief Financial Officer

Answer

SOX Section 302 requires the CEO and CFO to personally certify the accuracy of financial statements and the effectiveness of disclosure controls.

Question 5

In healthcare, 'credential padding' in provider enrollment refers to:

Accepted Answer

Falsely claiming board certifications to enroll as a specialist

Answer

Credential padding involves falsely listing certifications or training during enrollment to qualify for higher reimbursement rates.

(HAC) Healthcare Accounting Certification Practice Test