Chapter 1: Coding Fraud and Abuse

Question 1

HIPAA made coding fraud a federal offense and defines fraud as?

Answer 1

An international misrepresentation that someone makes, knowing is false, resulting in an unauthorized payment.

Question 2

With fraud, individuals deliberately intent to?

Answer 2

Collect unauthorized payments-they know what they’re doing.

Question 3

Selecting a medical code at a higher level than is justified by the patient’s medical record for the purpose of increasing the insurance reimbursement is known as?

Answer 3

Upcoding.

Question 4

Is Falsifying a patient’s diagnosis to justify the procedure is a fraudulent coding?

Answer 4

Yes.

Question 5

Assigning multiple CPT codes for a procedure covered by one code is known as?

Answer 5

Unbundling.

Question 6

Abuse also results in improper payments, is it done deliberately?

Answer 6

No.

Question 7

According to HIPAA, abuse involves?

Answer 7

Actions that are inconsistent with accepted, sound medical, business or fiscal practices.

Question 8

What is an example of Abusive coding practices?

Answer 8

Inadvertent coding errors.

Question 9

Penalties are heavy for individuals who knowingly and willfully commit insurance fraud and are intended to punish by?

Answer 9

Fines and imprisonment.

Question 10

Penalties for insurance abuse that is committed accidentally are intended to educate rather than punish and they typically involve?

Answer 10

Recovering overpayments from providers.