HMCC Fraud & Abuse Prevention

Question 1

What is healthcare fraud?

Accepted Answer

Knowingly and willfully executing or attempting to execute a scheme to defraud any healthcare benefit program

Answer

Accidentally submitting an incorrect billing code

Answer

Disagreeing with an insurance company's coverage decision

Answer

A patient providing inaccurate contact information

Question 2

What is upcoding in healthcare billing?

Accepted Answer

Billing for a more expensive service or procedure than what was actually provided

Answer

Using current billing codes instead of outdated ones

Answer

Coding a service at a lower level than performed

Answer

Updating billing software to the latest version

Question 3

What is the OIG Exclusion List?

Accepted Answer

A database of individuals and entities excluded from participation in federal healthcare programs due to fraud, abuse, or other violations

Answer

A list of medications not covered by insurance

Answer

A list of unapproved medical devices

Answer

A list of closed healthcare facilities

Question 4

What is the difference between fraud, waste, and abuse in healthcare?

Accepted Answer

Fraud involves intentional deception; waste involves overutilization without intent to deceive; abuse involves practices inconsistent with accepted standards

Answer

They are all the same thing

Answer

Only fraud is illegal

Answer

Waste and abuse are acceptable practices

Question 5

What is a compliance hotline and why is it important?

Accepted Answer

A confidential reporting mechanism allowing employees and others to report suspected compliance violations without fear of retaliation

Answer

A phone line for billing questions

Answer

A customer service line for patients

Answer

A hotline for scheduling appointments

Question 6

What is the Foreign Corrupt Practices Act (FCPA) and how does it relate to healthcare?

Accepted Answer

A US law prohibiting bribing foreign government officials, applicable when healthcare companies interact with government-owned hospitals or healthcare systems abroad

Answer

A law about importing foreign medications

Answer

A regulation about foreign medical graduates

Answer

A trade agreement between countries