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

Excluded individuals and entities may not participate in any federal healthcare program (Medicare, Medicaid, etc.), and healthcare organizations that employ excluded individuals may also face significant penalties.

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

The OIG's seven elements of an effective compliance program cover written policies, compliance officer, training, open communication, auditing, response to offenses, and disciplinary standards—no compliance program can promise immunity from a government audit.

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

Billing under another provider's NPI for services rendered by a different practitioner constitutes provider identity fraud and is a serious violation of Medicare billing rules.

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

HEAT is a joint HHS-DOJ initiative that coordinates federal, state, and local efforts to prevent and combat Medicare and Medicaid fraud, waste, and abuse.

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

Cost report fraud involves deliberately manipulating data in Medicare cost reports—such as including unallowable costs or misrepresenting expenses—to inflate reimbursements from Medicare.

NCICS - National Certified Insurance and Coding Specialist Practice Test

NCICS - National Certified Insurance and Coding Specialist Practice Test

NCICS Healthcare Fraud, Waste & Abuse Prevention 3