Cpma Practice Exam Question And Answers Rated A+ 2023

CMS Fraud Definition {Ans: } Making false statements or misrepresenting facts to obtain an undeserved benefit or payment from a federal healthcare programCMS Abuse Definition {Ans: } An action that results in unnecessary costs to a federal healthcare program, either directly or indirectlyCMS Examples of Fraud {Ans: } Billing for services and/or supplies that you know were not furnished or provided, altering claim forms and/or receipts to receive a higher payment amount, billing a Medicare patient above the allowed amount for services, billing for services at a higher level than provided or necessary, misrepresenting the diagnosis to justify paymentCMS Examples of Abuse {Ans: } Misusing codes on a claim, charging excessively for services or supplies, billing for services that were not medically necessary, failure to maintain adequate medical or financial records, improper billing practices, billing Medicare patients a higher fee schedule than non-Medicare patientsFalse Claims Act {Ans: } Any person is liable if they knowingly present or cause to be presented a false or fraudulent claim for payment or approval; knowingly makes, uses, or causes to be made or used, a false record or material to a false or fraudulent claimsCurrent False Claims Act penalties {Ans: } $5,500-$11,000 per claimWhen