Acronyms

Question 1

Describe the federal government auditing entity

HEAT

Answer 1

Health Care Fraud Prevention and Enforcement Action Team (HEAT)

Joint initiative of HHS, OIG, and DOI to fight health fraud through the Medicare Fraud Strike Force

Question 2

Describe the federal government auditing entity

MFCU

Answer 2

Medicaid Fraud Control Unit (MFCU)

State government entity certified by HHS to investigate/prosecute those defrauding Medicaid

Question 3

Describe the federal government auditing entity

MIP

Answer 3

Medicaid Integrity Program (MIP)

Created by the Deficit Reduction Act (2005) to combat fraud/abuse/waste in the Medicaid programs and help states combat fraud/abuse

Question 4

Describe the federal government auditing entity

MIC

Answer 4

Medicaid Integrity Contractor (MIC)

Contractors review provider activities, audit, and educate

Question 5

Describe the federal government auditing entity

MAC

Answer 5

Medicare Administrative Contractor (MAC)

Private health insurers contracted to process Medicare A and B or DME claims for Medicare Fee-for-Service beneficiaries

Question 6

Describe the federal government auditing entity

RAC

Answer 6

Medicare Recovery Audit Contractor (RAC)

Audit specialists identify/recover improper Medicare payments for Fee-for-service Medicare plans

Question 7

Describe the federal government auditing entity: CERT

Answer 7

Comprehensive Error Rate Testing Program (CERT)

Monitors accuracy of payments in Medicare Fee-for-Service program and performance of Medicare contractors.

Question 8

List and briefly describe the federal government auditing entity

OIG

Answer 8

Office of Inspector General (OIG)

Conducts investigation for fraud/misconduct for HHS programs

Question 9

List and briefly describe the federal government auditing entity

PERM

Answer 9

Payment Error Rate Measurement Program (PERM)

PERM measures improper payment in Medicaid and CHIP and provides error rates for the programs

Question 10

List and briefly describe the federal government auditing entity

RADV

Answer 10

Risk-Adjusted Data Validation (RADV)

CMS audits (annual and contract-level) accuracy of HCC codes for payment for Medicare Advantage plans and adjusts payments depending on participants’ health risks

Question 11

List and briefly describe the federal government auditing entity

Medicaid RAC

Answer 11

State Medicaid Recovery Audit Contractor (Medicaid RAC)

State programs are required to identify and recover improper Medicaid payments for those billing through the state’s Fee-for-Service Medicaid program.

Question 12

List and briefly describe the federal government auditing entities

OMIG

Answer 12

State Office of Medicaid Inspector General (OMIG)

Investigates Medicaid fraud at the states level

Question 13

List and briefly describe the federal government auditing entities

DOJ

Answer 13

US Department of Justice (DOJ)

Investigates fraud in HHS programs through OIG

Question 14

List and briefly describe the federal government auditing entities

ZPIC

Answer 14

Zone Program Integrity Contractor (ZPIC)

Seven regional programs established by CMS to combat fraud/waste/abuse in Medicare programs