HAC Internal Controls & Fraud Prevention 4

Question 1

Which statute imposes criminal penalties for knowingly and willfully paying or receiving remuneration to induce referrals of federally covered healthcare services?

Accepted Answer

Anti-Kickback Statute

Answer

The Anti-Kickback Statute (42 U.S.C. § 1320a-7b) criminalizes remuneration intended to induce or reward referrals of federal healthcare program business.

Question 2

A hospital's internal auditor discovers that a materials manager awarded supply contracts to a vendor in which the manager holds a 30% ownership stake. This is best described as:

Accepted Answer

Conflict of interest

Answer

A conflict of interest exists when an employee's personal financial interest influences—or appears to influence—their official decisions.

Question 3

Which COSO component requires management to identify and analyze risks that could prevent achievement of organizational objectives?

Accepted Answer

Risk Assessment

Answer

Risk Assessment is the COSO component where management systematically identifies and evaluates risks relevant to achieving objectives.

Question 4

An employee embezzles funds for three years before detection. Which control failure most likely allowed the fraud to persist?

Accepted Answer

Absence of mandatory vacation or job rotation policies

Answer

Mandatory vacation and job rotation force temporary coverage that often reveals concealed irregularities, limiting how long a fraud can go undetected.

Question 5

'Bundling' as a Medicare fraud scheme involves:

Accepted Answer

Billing separately for services that should be reported as a single combined code

Answer

Bundling fraud means billing components of a service individually (unbundling them) to collect more than the single bundled code would pay—though the term 'unbundling' is more precise, payers label the scheme 'improper unbundling.'

(HAC) Healthcare Accounting Certification Practice Test

(HAC) Healthcare Accounting Certification Practice Test

HAC Internal Controls & Fraud Prevention 4