Fraud, Waste And Abuse Training

5 Questions | Total Attempts: 212

SettingsSettingsSettings
Please wait...
Fraud Quizzes & Trivia

Fraud, Waste and Abuse Training Knowledge Check


Questions and Answers
  • 1. 
    Read the following scenario, then choose the answer that best fits the example.   The Attorney General of Pennsylvania filed criminal charges against two pharmacists for billing insurance claims for nearly $1 million worth of prescription drugs that were not prescribed by any doctors and were not dispensed to any customers. The pharmacists were also accused of creating drug prescriptions (Levitra, Marinol, Restoril and Pexeva) and submitting the claims to CMS for more than $155,000 in reimbursements. They also submitted more than $180,000 in claims by using the names of employees who worked for businesses near the pharmacy.   The law or statute that is violated in this example would be the:
    • A. 

      Civil False Claims Act

    • B. 

      Stark Statute

    • C. 

      Anti-Kickback Statute

  • 2. 
    Read the following scenario, then choose the answer that best fits the example.   A large pharmaceutical company encouraged a nursing home pharmacy to increase the number of elderly patients taking medication for a diagnosis that required prescriptions relating to psychosis. To do so, these pharmacists persuaded physicians to prescribe drugs manufactured by this pharmaceutical company for their patients. As a result, these actions increased market share for the pharmaceutical company’s antipsychotic drug against competing pharmaceutical companies.   In return for the nursing home pharmacy efforts, the drug maker paid the pharmacy tens of millions of dollars. The monies were based on the market share of some of the pharmaceutical company’s drugs, as well as sponsorship of the nursing home pharmacy meetings, and grants. They also made payments for nursing home pharmacy data, like the prescribing habits of doctors, previously provided to the drug maker for free.   The law or statute that is violated in this example would be the:
    • A. 

      Civil False Claims Act

    • B. 

      Stark Statute

    • C. 

      Anti-Kickback Statute

  • 3. 
    The following scenario represents a situation where fraud, waste and abuse can take place. Read through the scenario then answer the question that follows.   A person comes to your pharmacy to drop off a prescription for a beneficiary who is a “regular” customer. The prescription is for a controlled substance with a quantity of 160. This beneficiary normally receives a quantity of 60, not 160. You review the prescription and have concerns about possible forgery. What is your next step?
    • A. 

      Fill the prescription for 160

    • B. 

      Fill the prescription for 60

    • C. 

      Call the prescriber to verify quantity

    • D. 

      Call the sponsor’s compliance department

    • E. 

      Call law enforcement

  • 4. 
    The following scenario represents a situation where fraud, waste and abuse can take place. Read through the scenario then answer the question that follows.   Your job is to submit risk diagnosis to CMS for purposes of payment. As part of this job you are to verify, through a certain process, that the data is accurate. Your immediate supervisor tells you to ignore the sponsor’s process and to adjust/add risk diagnosis codes for certain individuals.  What do you do?
    • A. 

      Do what is asked of your immediate supervisor

    • B. 

      Report the incident to the compliance department (via compliance hotline or other mechanism)

    • C. 

      Discuss concerns with immediate supervisor

    • D. 

      Contact law enforcement

Back to Top Back to top