Fraud, Waste, and Abuse (FWA) Quiz

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* 1. The following can be considered fraud, except:

Unintentional errors

Deliberate omissions

False statements

Misrepresentations

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* 2. Which of the following could be considered fraud, waste, or abuse?

All of the answers.

Billing for procedures not done.

Providing more services than necessary.

Altering medical records to receive more reimbursement.

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* 3. The intentional act of deception, misrepresentation or concealment in order to gain something of value is:

All of the answers

Fraud

Abuse

Waste

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* 4. Improper use of services or actions that are inconsistent with acceptable business or medical practice is:

None of the answers

Fraud

Waste

Abuse

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* 5. Which of the following best describes “waste”?

Over-utilization of services (not caused by criminally negligent actions) and the misuse of resources.

Providing medically necessary services.

Billing for services that were never rendered.

Deliberately misrepresenting services, resulting in improper payments to the provider.

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* 6. Charging a member for any part of a covered benefit violates:

Federal Law

All of the answers

State Law

Health Plan contracting

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* 7. Which of the following is NOT an example of an illegal action under the “False Claims Act”?

All of the answers

A physician who treats more than 20 patients a day.

A physician who submits a bill to Medicare for medical services not provided.

A government contractor who submits records that he knows (or should know) is false and that indicates compliance with certain contractual or regulatory requirements.

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* 8. Which of the following is an example of fraud?

Billing an insurance company for CPT- code 90807 (extended therapy, 30-40 minutes with medication management) when the patient saw the doctor for 15 minutes.

Not entering a bill after a patient visit is completed.

Billing an insurance company for CPT-code 90805 (brief therapy with medication management) when the patient saw the doctor for 30 minutes.

None of the answers.

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* 9. Which of the following could be considered fraud, waste, or abuse?

Billing for a higher level than the service actually delivered.

Billing for services not provided.

All of the answers.

Billing for non-covered services or prescriptions as covered items.

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* 10. A provider’s office regularly will charge all new patients a $10 administrative fee to schedule the first appointment and complete all medical forms. This is an allowable fee for Medicare patients.

True

False

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* 11. Please provide us with your contact information below (first and last name, company name, email address, and phone#).

Name

Company

Email Address

Phone Number