Fraud and Abuse

Question 1

What is the difference between fraud and abuse?

Answer 1

Intentions. Fraud is knowing, abuse is not knowing.

Question 2

Define waste

Answer 2

Inappropriate use of resources, not criminal.

Question 3

Which is most common: Fraud, abuse, or waste?

Answer 3

Waste

Question 4

Which act protects the federal government from being overcharged or sold substandard goods/services?

Answer 4

False Claims Act

Question 5

Define Safe Harbor

Answer 5

Conduct that is explicitly permissible and protected from liability under a statute. e.g. IOAS is safe under Stark

Question 6

Define Anti-kickback statute

Answer 6

Criminal offense to knowingly and willfully offer, pay, solicit, or receive bribes or kickbacks to induce or reward referrals in order to induce business reimbursable by a federal health care program. “something for nothing” e.g. cash payment, trips/fancy dinners.

Question 7

An exception under the Stark Statute is:

Answer 7

In-office ancillary services

Question 8

According to Exclusion Statute, the OIG is REQUIRED to exclude what?

Answer 8

medicare or medicaid fraud, patient abuse or neglect, felony convictions related to controlled substances.

Question 9

According to the Exclusion Statute, the OIG MAY exclude what?

Answer 9

misdemeanors, defaulting on student loan debt, unlawful kickback arrangements, suspension/revocation of license.

Question 10

Most common reason for those excluded from doing business with medicare?

Answer 10

Revocation or voluntary surrender of clinician license.

Question 11

Initial consent to treat applies to:

Answer 11

Treatment, health operations, and payment.