NCICS Healthcare Fraud, Waste & Abuse Prevention 3

Question 1

Under the OIG Exclusion Program, individuals or entities that are excluded are prohibited from:

Accepted Answer

Participating in any federal or state healthcare programs, including Medicare and Medicaid

Answer

Practicing medicine in any U.S. state

Answer

Billing private commercial insurance companies for services rendered

Answer

Employing other licensed healthcare professionals

Question 2

Which of the following elements is NOT typically included in an effective OIG-compliant healthcare compliance program?

Accepted Answer

Guaranteeing employees will never be subject to a government audit

Answer

Written policies and procedures addressing fraud, waste, and abuse

Answer

Designation of a compliance officer and compliance committee

Answer

Effective training and education programs for all employees

Question 3

A provider bills Medicare services under one physician's National Provider Identifier (NPI) for procedures actually performed by a different, non-credentialed practitioner. This constitutes:

Accepted Answer

Provider identity fraud

Answer

Upcoding

Answer

Unbundling

Answer

Cost report fraud

Question 4

The Healthcare Fraud Prevention and Enforcement Action Team (HEAT) is a joint initiative between:

Accepted Answer

The Department of Health and Human Services (HHS) and the Department of Justice (DOJ)

Answer

CMS and the American Medical Association

Answer

The OIG and state Medicaid programs only

Answer

The FBI and state insurance departments

Question 5

Which of the following best describes 'cost report fraud' in the hospital Medicare context?

Accepted Answer

Deliberately manipulating a hospital's cost report to obtain higher Medicare reimbursements than are legitimately owed

Answer

Billing patients more than the Medicare allowable rate

Answer

Charging different prices to insured versus uninsured patients for the same service

Answer

Submitting claims without proper procedure code documentation

Question 6

What is the primary role of a Chief Compliance Officer (CCO) in a healthcare organization?

Accepted Answer

Overseeing the development, implementation, and monitoring of the compliance program

Answer

Reviewing and approving all patient medical records for accuracy

Answer

Processing and submitting insurance claims on behalf of the billing department

Answer

Negotiating reimbursement contracts with commercial insurance payers

Question 7

Under 18 U.S.C. § 1347 (the federal Health Care Fraud statute), conviction for knowingly executing a scheme to defraud a healthcare benefit program can result in:

Accepted Answer

Criminal imprisonment and fines

Answer

Civil monetary penalties and license suspension only

Answer

Mandatory continuing medical education requirements

Answer

Repayment of fraudulent claims with no additional penalty