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1. Which of these requires intent to get paid and knowing the actions are wrong?*
2. Which of these is NOT a potential penalty for violating laws or regulations prohibiting fraud, waste, and abuse (FWA)?*
3. A person drops off a prescription for a patient who’s a regular pharmacy customer. The prescription is for a controlled substance with a quantity of 160. This patient normally gets a quantity of 60, not 160. You review the prescription and have concerns about possible forgery. What’s your next step?*
4. You’re responsible for submitting a risk diagnosis to CMS for payment purposes. You use a specific process to verify the data is accurate. Your immediate supervisor tells you to ignore the process and adjust or add risk diagnosis codes for certain individuals. What should you do?*
5. You’re responsible for paying provider claims. You notice a certain diagnostic provider (Doe Diagnostics) requested substantial payment for a large patient group. Many claims are for a specific procedure. You review the same procedure type for other diagnostic providers and realize Doe Diagnostics’ claims far exceed any other provider you reviewed. What should you do?*
6. You’re performing regular inventory of the pharmacy’s-controlled substances. You discover a minor inventory discrepancy. What should you do?*
7. Once a corrective action plan is started, the corrective actions must be monitored annually to ensure they’re effective.*
8. Ways to report potential fraud, waste, and abuse (FWA) include:*
9. Any person who knowingly submits false claims to the government is liable for 5 times the government’s damages caused by the violator plus a penalty.*
10. These are examples of issues that should be reported to a compliance department: suspected fraud, waste, and abuse (FWA); potential health privacy violation; unethical behavior; and employee misconduct.*
11. Bribes or kickbacks of any kind for services paid under a federal health care program (which includes Medicare) constitute fraud by the person making as well as the person getting them.*
12. Waste includes any misuse of resources, like overusing services or other practices that, directly or indirectly, result in unnecessary Medicare Program cost.*
13. Abuse involves items or services payment when there’s no legal entitlement to that payment and the provider hasn’t knowingly or intentionally misrepresented facts to get paid.*
14. Some of the laws governing Medicare Parts C and D fraud, waste, and abuse (FWA) include the Health Insurance Portability and Accountability Act (HIPAA), the Federal Civil False Claims Act, the Anti-Kickback Statute, and the Criminal Health Care Fraud Statue.*
15. You can help prevent fraud, waste, and abuse (FWA) by doing all these:*
Look for suspicious activity. Conduct yourself ethically. Ensure accurate and timely data and billing. Ensure you coordinate with other payers. Keep up to date with FWA policies and procedures, standards of conduct, laws, regulations, and CMS guidance. Verify all information provided to you
16. What are some penalties for violating fraud, waste, and abuse (FWA) laws?*