Medicare Advantage And Part D Fraud, Waste And Abuse Compliance Training 2009

10 Questions | Total Attempts: 247

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Medicare Quizzes & Trivia

Medicare Advantage and Part D Fraud, Waste and Abuse Compliance Training 2009 Quiz


Questions and Answers
  • 1. 
    A party that enters into a written arrangement, acceptable to CMS, with a Plan Sponsor to provide administrative services or health care services for a Medicare eligible individual under the MA or Part D programs is called a:
    • A. 

      Related Entity

    • B. 

      Downstream Entity

    • C. 

      First Tier Entity

    • D. 

      Plan Sponsor

  • 2. 
    An entity that is related to the Plan Sponsor by common ownership or control and performs some of the Plan Sponsor's management functions under contract or delegation; furnishes services to Medicare enrollees under an oral or written agreement; or leases real property or sells materials to the Plan Sponsor at a cost of more than $2,500 during a contract period is a:
    • A. 

      Related Entity

    • B. 

      First Tier Entity

    • C. 

      Plan Sponsor

    • D. 

      Downstream Entity

  • 3. 
    An entity that has a contract with CMS to offer one or more of the following Medicare Products: Medicare Advantage (MA) Plans, Medicare Advantage Prescription Drug Plans, Prescription Drug Plans (PDP) and 1878 Cost Plans is a:
    • A. 

      First Tier Entity

    • B. 

      Plan Sponsor

    • C. 

      Downstream Entity

    • D. 

      Related Entity

  • 4. 
    A party that enters into a written arrangement, acceptable to CMS, with persons or entities involved in the MA or Part D benefit, below the level of the arrangement between a Plan Sponsor and a first tier entity is a:
    • A. 

      Related Entity

    • B. 

      First Tier Entity

    • C. 

      Proposal Sponsor

    • D. 

      Downstream Entity

  • 5. 
    Detecting, correcting and preventing fraud, waste and abuse requires collaboration between:
    • A. 

      Beneficiaries

    • B. 

      You

    • C. 

      Providers of services

    • D. 

      State and Federal agencies

    • E. 

      All of the above

  • 6. 
    The intentional act of deception, misrepresentation or concealment in order to gain something of value is:
    • A. 

      Fraud

    • B. 

      Abuse

    • C. 

      Waste

    • D. 

      None of the above

  • 7. 
    Excessive or improper use of services or actions that are inconsistent with accept business or medical practice is:
    • A. 

      Fraud

    • B. 

      Abuse

    • C. 

      Waste

    • D. 

      None of the above

  • 8. 
    Over-utilization of services and the misuse of resources is:
    • A. 

      Fraud

    • B. 

      Abuse

    • C. 

      Waste

    • D. 

      None of the above

  • 9. 
    Inappropriate billing practices include:
    • A. 

      Billing for non-covered services or prescriptions as covered items

    • B. 

      Billing for a higher level than the service actually delivered

    • C. 

      Billing for services not provided

    • D. 

      Misrepresenting the service that was provided

    • E. 

      All of the above

  • 10. 
    Which Statute/Act/Law prohibits physicians from referring Medicare patient to an entity with which the physician or the physician's immediate family member has a financial relationship (unless an exception applies):
    • A. 

      Stark Law

    • B. 

      False Claims Act

    • C. 

      Anti-Kickback Statute

    • D. 

      None of the above

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