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Combating Medicare Parts C and D Fraud, Waste, and Abuse

  1. Once a corrective action plan is started, the corrective actions must be monitored annually to ensure they are effective
    1. True
    2. False

  2. The following ways can be used to report potential Fraud, Waste, and Abuse (FWA): Telephone hotlines, Mail drops, In person reporting to the compliance supervisor, and Special Investigation Units.
    1. True
    2. False

  3. Any person who knowingly submits false claims to the Government is liable for five times the Government's damages caused by the violator plus a penalty.
    1. True
    2. False

  4. These are examples of issues that should be reported to a Compliance Department: suspected Fraud, Wastes, and Abuse (FWA), potential health privacy violation, and unethical behavior/employee misconduct
    1. True
    2. False

  5. Bribes or kickbacks of any kind for services that are paid under a Federal health care program (which includes Medicate) constitute fraud by the person making as well as the person receiving them
    1. True
    2. False

  6. Waste includes any misuse of resources such as the overuse of services, or other practices that, directly or indirectly, result in unnecessary costs to the Medicare Program.
    1. True
    2. False

  7. Abuse involves payment for items or services where there is no legal entitlement to that payment and the provider has not knowingly and/or intentionally misrepresented facts to obtain payment.
    1. True
    2. False

  8. Some of the laws governing Medicare Part C and Fraud D, Waste, and Abuse (FWA) include the Health Insurance Portability and Accountability Act (HIPAA); the False Claims Act; the Anti-Kickback Statute; the List of Excluded Individuals and Entities (LEIE); and the Health Care Fraud Statute.
    1. True
    2. False

  9. You can help prevent Fraud, Waste, and Abuse (FWA) by doing all of the following:
    - Look for suspicious activity;
    - Conduct yourself in an ethical manner;
    - Ensure accurate and timely data/billing;
    - Ensure you coordinate with other payers;
    - Keep up to date with FWA policies and procedures, standards of conduct, laws, regulations, and the Centers for Medicare & Medicaid Services (CMS) guidance; and
    - Verify all information provided to you
    1. True
    2. False

  10. What are some of the penalties for violating Fraud, Waste, and Abuse (FWA) laws?
    1. Civil Monetary Penalties
    2. Imprisonment
    3. Exclusion from participation in all Federal health care programs
    4. All of the above



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