Health Care Fraud

Question 1

Fictious services

Answer 1

Healthcare providers charge or bill healthcare program for services not rendered at all

Question 2

Rolling Labs

Answer 2

mobile lab for health screening tests at no cost to patient

Question 3

What type of fraud is altered claims

Answer 3

Inflated billing Schemes

Question 4

What type of fraud is Code manipulation

Answer 4

Inflated billing schemes

Question 5

What is unbundling charges and fragmentation

Answer 5

some provides increase profits by billing separately for procedures part of single procedure

Question 6

What is mutually exclusive procedures

Answer 6

billing for procedures impossible to perform together

Question 7

What is upcoding

Answer 7

Provide bills for higher level of service than rendered

Question 8

DRG Creep

Answer 8

1. Diagnostic-related groupings (medically related)
2. manipulate diagnostic/procedural codes to increase reimbursement amounts