NCICS Healthcare Fraud, Waste & Abuse Prevention 2

Question 1

The Anti-Kickback Statute (AKS) prohibits which of the following activities?

Accepted Answer

Offering or receiving anything of value to induce or reward referrals for services covered by federal healthcare programs

Answer

The Anti-Kickback Statute prohibits offering, paying, soliciting, or receiving anything of value to induce or reward referrals or generate business reimbursable by federal healthcare programs.

Question 2

A hospital bills Medicare separately for each component of a complex procedure—such as the procedure itself, radiologist interpretation, and supplies—when a single comprehensive CPT code should cover all components. This is known as:

Accepted Answer

Unbundling

Answer

Unbundling occurs when a provider bills each component of a procedure separately to receive higher total reimbursement instead of using the single comprehensive code that covers all components.

Question 3

A 'qui tam' lawsuit filed under the False Claims Act allows:

Accepted Answer

Private citizens to file suit on behalf of the government and share in any financial recovery

Answer

The qui tam provision allows private individuals (relators) to file suit on behalf of the government against those who defraud federal programs and receive a percentage of any recovery.

Question 4

Recovery Audit Contractors (RACs) are primarily designed to:

Accepted Answer

Identify and recover improper Medicare and Medicaid payments after they have been made

Answer

RACs identify and recover improper payments—both overpayments and underpayments—in Medicare and Medicaid programs through post-payment audits of provider claims.

Question 5

A provider submits the same claim to Medicare twice for a single patient visit that occurred only once. This is an example of:

Accepted Answer

Double billing

Answer

Double billing (duplicate billing) involves submitting the same claim more than once for a service performed only once, resulting in improper duplicate payment.

NCICS - National Certified Insurance and Coding Specialist Practice Test

NCICS - National Certified Insurance and Coding Specialist Practice Test

NCICS Healthcare Fraud, Waste & Abuse Prevention 2