Fraud Abuse

Question 1

What is fraud

Answer 1

Intentional deception, misrepresentation

Individual knows that the false information reported could result in a benefit to that person.

Question 2

Examples of fraud

Answer 2

Billing for services that were not provided
“Up-coding”
False diagnosis
Altering claims

Question 3

What is abuse

Answer 3

An incident or practice that is not consistent with sound medical, business, or fiscal practice.

Question 4

example of abuse

Answer 4

Providing unnecessary care

Providing sub-optimal care

Question 5

Fraud alerts are

Answer 5

Notifications of practices that are being investigated so physicians can look at their own practices and make corrections.

Question 6

If found guilty of fraud or abuse,

Answer 6

physicians can be excluded from participating in Medicare and Medicaid programs.
Payment if cut off for 5 years

Question 7

stark law

Answer 7

Physician cannot have a financial relationship with an entity that provides health care services.
Does office make referrals for Medicare/caid patients?
2. Is there a financial relationship between the practice and the referral entity?

Question 8

tickler system

Answer 8

these are 3x5 cards kept in a box, filed by month, to and pulled to generate a reminder to the patient of an appointment.
Electronic packages will also generate a letter to the patient if it has a tickler system.
Condolence letters should always be personalized

Question 9

never document on

Answer 9

printed version EMR