{"id":116878,"date":"2023-08-26T11:23:05","date_gmt":"2023-08-26T11:23:05","guid":{"rendered":"https:\/\/learnexams.com\/blog\/?p=116878"},"modified":"2023-08-26T11:23:30","modified_gmt":"2023-08-26T11:23:30","slug":"fraud-waste-and-abuse-fwabundled-exams-questions-and-answers-2022-2023-certified-solutions","status":"publish","type":"post","link":"https:\/\/www.learnexams.com\/blog\/2023\/08\/26\/fraud-waste-and-abuse-fwabundled-exams-questions-and-answers-2022-2023-certified-solutions\/","title":{"rendered":"Fraud Waste and Abuse (FWA)Bundled Exams Questions and Answers (2022\/2023) (Certified Solutions)"},"content":{"rendered":"\n<p>Fraud, Waste, Abuse \u2013 1 (2022\/2023)<br>Graded A+<br>ACA Section 1557 differs from earlier legislation in providing broader protection against<br>discrimination based on<br>a. disability.<br>b. national origin.<br>c. age.<br>d. sex. \u2714\u2714d<br>Section 1557 of the Affordable Care Act applies to<br>a. all health programs and activities administered by or receiving federal financial assistance<br>from HHS.<br>b. Medicare Advantage plans only.<br>c. all health programs and activities, public and private.<br>d. health plans sold through the ACA Marketplaces only. \u2714\u2714a<\/p>\n\n\n\n<p>Which Medicare programs are covered by ACA Section 1557?<br>a. Part C (Medicare Advantage) only.<br>b. Parts A, C, and D, but not B.<br>c. Part D (prescription drug coverage) only.<br>d. Parts A and B (Original Medicare) only. \u2714\u2714b<br>Under ACA Section 1557, prohibited actions involve<br>a. marketing only.<br>b. claims only.<br>c. eligibility, claims, and marketing.<br>d. eligibility only. \u2714\u2714c<br>Under ACA Section 1557, a person<br>a. can be discriminated against if she is unable to speak English.<br>b. can be discriminated against if she is an immigrant (legal or illegal).<\/p>\n\n\n\n<p>Fraud Waste and Abuse (FWA) Training<br>Questions and Answers 100% Pass<br>How to recognize FWA in the Medicare Program \u2714\u2714Knowledge of the law including the Civil<br>False claims Act, Health Care Fraud Statute, and Criminal Fraud, Anti-Kickback Statute, Stark<br>Statute, Exclusion from all Federal healthcare programs, and the Health Insurance Portability and<br>Accountability Act.<br>Civil False Claims Act \u2714\u2714Makes a person liable to pay damages to the government if<\/p>\n\n\n\n<ol class=\"wp-block-list\">\n<li>He or she knowingly conspires to commit FWA.<\/li>\n\n\n\n<li>Carries out other acts to obtain property from the government by misrepresentation.<\/li>\n\n\n\n<li>Conceals or improperly avoids or decreases an obligation to pay the government.<\/li>\n\n\n\n<li>Makes or uses a false record or statement supporting a false claim.<\/li>\n\n\n\n<li>Presents a false claim for payment or approval.<br>Health Care Fraud statute \u2714\u2714&#8221;Whoever knowingly and willfully executes, or attempts to<br>execute, a scheme or artifice of defraud any healthcare benefit program\u2026shall be fined under this<br>title or imprisoned not more than 10 years, or both.&#8221;<\/li>\n\n\n\n<li><\/li>\n<\/ol>\n\n\n\n<p>AHIP TRAINING Medicare Fraud, Waste,<br>and Abuse Training Questions and<br>Answers with Verified Solutions<br>Medicare plan means \u2714\u2714A MA plan, MA-PD plan or PDP<br>Subcontractor means \u2714\u2714<strong>An individual or entity that provides services on behalf of a Medicare plan sponsor. This includes individuals and organizations with DIRECT relationship with the plan sponsor or individuals or organizations with INDIRECT relationship, such as an agent who has a contract with an agency or filed marketing organization that contract with a Medicare plan. FWA Training: A compliance program component \u2714\u2714<\/strong>ALL Medicare plans are required to<br>have robust programs to assure compliance by plan employees an subcontractors with all<br>applicable laws, regulations and program guidance.<br>**One required component of a compliance program is a FWA program to identify and address<br>issues of compliance with FWA.<br>**It is important to remember that ALL Medicare plan sponsor employees and subcontractors<br>are responsible for complying with all relevant Medicare requirements, even if lack of<br>compliance may not be viewed as FWA,<\/p>\n\n\n\n<p>FWA: Why participate in the training \u2714\u2714**Fraud, waste and abuse impacts everyone who<br>receives or relies on healthcare in the US.<br>**The purpose of this training is to help you detect, correct and prevent FWA and your help is<br>needed. You are part of the solution!<br><strong>As a subcontractor to or an employee of a Medicare plan, you are required to participate in FWA training. FWA: Combating: A federal priority \u2714\u2714<\/strong>Important priority for the Federal Government.<br>**CMS, the Federal agency responsible for administering these programs, takes its role in<br>leading anti-fraud efforts very seriously and has issued strict requirements for those involved in<br>providing MA and Medicare Part D coverage.<br>**The office of Inspector General, a sister agency to CMS within the US Department of Health<br>and Human Services , is also actively involved in anti-fraud efforts.<br>Steps by Medicare plans to Combat FWA \u2714\u2714&#8211;The establishment and operation of special<br>investigation units (SIU) or other existing departments that perform an internal investigation<br>function<br>&#8211;The analysis of claims data<br>&#8211;Collaboration with law enforcement agencies<\/p>\n\n\n\n<p>&#8211;Adherence to rules set forth by CMS regarding efforts to identify and prevent fraud, waste and<br>abuse.<br>CMS Anti-FWA requirements for Medicare plans \u2714\u2714&#8211;Actively seek to prevent fraud, waste<br>and abuse<br>&#8211;Detect and investigate suspected FWA<br>&#8211;Implement corrective action when instances of FWA are uncovered<br>&#8211;Have a system in place 24 hrs per day for employees and subcontractors to voluntarily, and<br>confidentially report suspected FWA or misconduct related to the MA and Part D programs<br>CMS FWA training requirements for a Sponsor&#8217;s Employees \u2714\u2714**CMS requires Medicare plan<br>sponsors to provide training in FWA to their employees involved in Medicare plan work.<br>*<em>This training must occur within 90 days of hire and annually thereafter. CMS FWA training requirements: Agents, Brokers and other Subcontractors \u2714\u2714<\/em>*The FWA<br>training must be received not only by Medicare plan sponsor employees but also by<br>subcontractors and their employees who are under contract to provide health or administrative<br>services. The EXCEPTIONS are limited to:<br>***accredited suppliers of DME, prosthetics, orthotics, and supplies (DMEPOS)<br>***Healthcare providers who are enrolled in Medicare Part A\/B<\/p>\n\n\n\n<p>Fraud, Waste, Abuse \u2013 2 Latest 2023<br>Graded A+<br>Ways to report potential Fraud, Waste, and Abuse (FWA) include:<br>a. Telephone hotlines<br>b. Mail Drops<br>c. In-person reporting to the compliance department\/supervisor<br>d. Special Investigations Units (SIUs)<br>e. All of the above \u2714\u2714e<br>Once a corrective action plan is started, the corrective actions must be monitored annually to<br>ensure they are effective.<br>:<br>True False \u2714\u2714false<br>Any person who knowingly submits false claims to the Government is liable for five times the<br>Government&#8217;s damages caused by the violator plus a penalty.<\/p>\n\n\n\n<p>AHIP fraud waste &amp; abuse questions and<br>answers already passed<br>Which of the following requires intent to obtain payment and the knowledge that the actions are<br>wrong? \u2714\u2714Fraud<br>Which of the following is not potentially a penalty for violation of the law or regulation<br>prohibiting fraud, waste and abuse (fwa)? \u2714\u2714Deportation<br>A person comes into your pharmacy to drop off a prescription for a beneficiary who is a regular<br>customer. The prescription is for a controlled substance with a quantity of 160. This beneficiary<br>normally receives a quantity of 60, not 160. You review the prescription and have concerns<br>about the possible forgery. What is your next step? \u2714\u2714Call the prescriber to verify the quantity<br>Your job is to submit risk diagnosis to the centers for Medicare &amp; medicaid services (cms) for<br>the purpose of payment. As part of this job you verify, through a certain process, that the data is<br>accurate. Your immediate supervisor tells you to ignore the sponsors process and to adjust\/add<br>risk diagnosis codes for certain individuals. What should you do? \u2714\u2714Report the incident to the<br>compliance department (via compliance hotline or other mechanism)<\/p>\n\n\n\n<p>Medicare Fraud, Waste, &amp; Abuse<br>(2022\/2023) (Certified Answers)<br>Your job is to submit a risk diagnosis to the Centers for Medicare &amp; Medicaid Services (CMS)<br>for the purpose of payment. As part of this job, you use a process to verify the data is accurate.<br>Your immediate supervisor tells you to ignore the Sponsor&#8217;s process and to adjust or add risk<br>diagnosis codes for certain individuals. What should you do?<br>a.Do what your immediate supervisor asked you to do and adjust or add risk diagnosis codes<br>b.Report the incident to the compliance department (via compliance hotline or other mechanism)<br>c.Discuss your concerns with your immediate supervisor<br>d.Call law enforcement \u2714\u2714Report the incident to the compliance department (via compliance<br>hotline or other mechanism)<br>Which of the following is NOT potentially a penalty for violation of a law or regulation<br>prohibiting fraud, waste, and abuse (FWA)?<br>a.Civil Monetary Penalties<br>b.Exclusion from participation in all Federal health care programs<br>c.Deportatio \u2714\u2714Deportation<\/p>\n\n\n\n<p>Which of the following requires intent to obtain payment and the knowledge the actions are<br>wrong?<br>a.Fraud<br>b.Waste<br>c.Abuse \u2714\u2714Fraud<br>A person drops off a prescription for a beneficiary who is a &#8220;regular&#8221; customer. The prescription<br>is for a controlled substance with a quantity of 160. This beneficiary normally receives a quantity<br>of 60, not 160. You review the prescription and have concerns about possible forgery. What is<br>your next step?<br>a.Call law enforcement<br>b.Call the prescriber to verify the quantity<br>c.Call the Sponsor&#8217;s compliance department<br>d.Fill the prescription for 160<br>e.Fill the prescription for 60 \u2714\u2714Call the prescriber to verify the quantity<\/p>\n\n\n\n<p>Combating Medicare Parts C&amp;D Fraud,<br>Waste &amp; Abuse Questions and Answers<br>100% Pass<br>Once a corrective action plan is started, the corrective actions must be monitored annually to<br>ensure they are effective. \u2714\u2714False<br>Ways to report potential fraud, waste, and abuse (FWA) include: \u2714\u2714All of the above<br>Any person who knowingly submits false claims to the government is liable for five times the<br>government&#8217;s damages caused by the violator plus a penalty. \u2714\u2714False<br>These are examples of issues that should be reported to a compliance department: suspected<br>fraud, waste, and abuse (FWA); potential health privacy violation; unethical behavior; and<br>employee misconduct. \u2714\u2714True<br>Bribes or kickbacks of any kind for services that are paid under a federal health care program<br>(which includes medicare) constitute fraud by the person making as well as the person receiving<br>them. \u2714\u2714True<\/p>\n\n\n\n<p>Combating Medicare Parts C&amp;D Fraud,<br>Waste &amp; Abuse Questions and Answers<br>100% Pass<br>Once a corrective action plan is started, the corrective actions must be monitored annually to<br>ensure they are effective. \u2714\u2714False<br>Ways to report potential fraud, waste, and abuse (FWA) include: \u2714\u2714All of the above<br>Any person who knowingly submits false claims to the government is liable for five times the<br>government&#8217;s damages caused by the violator plus a penalty. \u2714\u2714False<br>These are examples of issues that should be reported to a compliance department: suspected<br>fraud, waste, and abuse (FWA); potential health privacy violation; unethical behavior; and<br>employee misconduct. \u2714\u2714True<br>Bribes or kickbacks of any kind for services that are paid under a federal health care program<br>(which includes medicare) constitute fraud by the person making as well as the person receiving<br>them. \u2714\u2714True<\/p>\n\n\n\n<p>Combating Medicare Parts C and D<br>Fraud, Waste, and Abuse \u2013 2012\/2023<br>Already Passed<br>Bribes or kickbacks of any kind for services that are paid under a Federal healthcare program<br>(which includes Medicare) constitute fraud by the person making as well as the person receiving<br>them. \u2714\u2714True<br>Once a corrective action plan is started, the corrective actions must be monitored annually to<br>ensure they are effective. \u2714\u2714False<br>Any person who knowingly submits false claims to the Government is liable for five times the<br>Government&#8217;s damages caused by the violator plus a penalty. \u2714\u2714False<br>Waste indicates any misuse of resources such as the overuse of services, or other practices that<br>directly or indirectly result in unnecessary costs to the Medicare Program. \u2714\u2714True<br>These are examples of issues that should be reported to a Compliance Department: suspected<br>fraud, waste, and abuse (FWA); potential health privacy violation; and unethical<br>behavior\/employee misconduct. \u2714\u2714True<\/p>\n\n\n\n<p>AHIP FWA 2023 Questions and Answers<br>100% Pass<br>Mrs. Turner is comparing her employer&#8217;s retiree insurance to Original Medicare and would like<br>to know which of the following services Original Medicare will cover if the appropriate criteria<br>are met? What could you tell her? \u2714\u2714Original Medicare covers ambulance services.<br>Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare Advantage<br>plan. What should you tell him? \u2714\u2714Mr. Singh can enroll in a stand-alone prescription drug plan<br>and continue to be covered for Part A and Part B services through Original Fee-for-Service<br>Medicare.<br>Mrs. Shields is covered by Original Medicare. She sustained a hip fracture and is being<br>successfully treated for that condition. However, she and her physicians feel that after her<br>lengthy hospital stay she will need a month or two of nursing and rehabilitative care. What<br>should you tell them about Original Medicare&#8217;s coverage of care in a skilled nursing facility?<br>\u2714\u2714Medicare will cover Mrs. Shield&#8217;s skilled nursing services provided during the first 20 days<br>of her stay, after which she would have a copay until she has been in the facility for 100 days.<br>Madeline Martinez was widowed several years ago. Her husband worked for many years and<br>contributed into the Medicare system. He also left a substantial estate which provides Madeline<\/p>\n\n\n\n<p>with an annual income of approximately $130,000. Madeline, who has only worked part-time for<br>the last three years, will soon turn age 65 and hopes to enroll in Original Medicare. She comes to<br>you for advice. What should you tell her? \u2714\u2714You should tell Madeline that she will be able to<br>enroll in Medicare Part A without paying monthly premiums due to her husband&#8217;s long work<br>record and participation in the Medicare system. You should also tell Madeline that she will pay<br>Part B premiums at more than the standard lowest rate but less than the highest rate due her<br>substantial income.<br>Mrs. West wears glasses and dentures and has enjoyed considerable pain relief from arthritis<br>through massage therapy. She is concerned about whether or not Medicare will cover these items<br>and services. What should you tell her? \u2714\u2714Medicare does not cover massage therapy, or, in<br>general, glasses or dentures.<br>Mrs. Quinn recently turned 66 and decided after many years of work to begin receiving Social<br>Security benefits. Shortly thereafter Mrs. Quinn received a letter informing her that she has been<br>automatically enrolled in Medicare Part B. She wants to understand what this means. What<br>should you tell Mrs. Quinn? \u2714\u2714Part B primarily covers physician services. She will be paying a<br>monthly premium and, with the exception of many preventive and screening tests, generally will<br>have 20% coinsurance for these services, in addition to an annual deductible.<\/p>\n\n\n\n<p>Mrs. Geisler&#8217;s neighbor told her she should look at her Part D options during the annual<br>Medicare enrollment period because features of Part D might have changed. Mrs. Geisler can&#8217;t<br>remember what Part D is so she called you to ask what her neighbor was talking about. What<br>could you tell her? \u2714\u2714Part D covers prescription drugs and she should look at her premiums,<br>formulary, and cost-sharing among other factors to see if they have changed.<br>Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has recently reviewed her<br>Medicare Summary Notice (MSN) and disagrees with a determination that partially denied one<br>of her claims for services. What advice would you give her? \u2714\u2714Mrs. Duarte should file an<br>appeal of this initial determination within 120 days of the date she received the MSN in the mail.<br>Mr. Rainey is experiencing paranoid delusions and his physician feels that he should be<br>hospitalized. What should you tell Mr. Rainey (or his representative) about the length of an<br>inpatient psychiatric hospital stay that Medicare will cover? \u2714\u2714Medicare will cover a total of<br>190 days of inpatient psychiatric care during Mr. Rainey&#8217;s entire lifetime.<br>Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs. Park<br>that might be of assistance? \u2714\u2714She should contact her state Medicaid agency to see if she<br>qualifies for one of several programs that can help with Medicare costs for which she is<br>responsible.<\/p>\n\n\n\n<p>Anita Magri will turn age 65 in August 2022. Anita intends to enroll in Original Medicare Part A<br>and Part B. She would also like to enroll in a Medicare Supplement (Medigap) plan. Anita&#8217;s<br>older neighbor Mel has told her about the Medigap Part F plan in which he is enrolled. It not<br>only provides foreign travel emergency benefits but also covers his Medicare Part B deductible.<br>Anita comes to you for advice. What should you tell her? \u2714\u2714You are sorry to disappoint Anita<br>but a Medigap Part F plan is no longer available to those who turn age 65 after January 1,2020.<br>Anita might instead consider other Medigap plans that offer foreign travel benefits but do not<br>cover the Part B deductible.<br>Ms. Henderson believes that she will qualify for Medicare Coverage when she turns 65, without<br>paying any premiums, because she has been working for 40 years and paying Medicare taxes.<br>What should you tell her? \u2714\u2714To obtain Part B coverage, she must pay a standard monthly<br>premium, though it is higher for individuals with higher incomes.<br>Mr. Alonso receives some help paying for his two generic prescription drugs from his employer&#8217;s<br>retiree coverage, but he wants to compare it to a Part D prescription drug plan. He asks you what<br>costs he would generally expect to encounter when enrolling into a standard Medicare Part D<br>prescription drug plan. What should you tell him? \u2714\u2714He generally would pay a monthly<br>premium, annual deductible, and per-prescription cost-sharing.<br><\/p>\n\n\n\n<p>AHIP FWA 2023 Questions and Answers<br>with Verified Solutions<br>Mrs. Turner is comparing her employer&#8217;s retiree insurance to Original Medicare and would like<br>to know which of the following services Original Medicare will cover if the appropriate criteria<br>are met? What could you tell her? \u2714\u2714Original Medicare covers ambulance services.<br>Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare Advantage<br>plan. What should you tell him? \u2714\u2714Mr. Singh can enroll in a stand-alone prescription drug plan<br>and continue to be covered for Part A and Part B services through Original Fee-for-Service<br>Medicare.<br>Mrs. Shields is covered by Original Medicare. She sustained a hip fracture and is being<br>successfully treated for that condition. However, she and her physicians feel that after her<br>lengthy hospital stay she will need a month or two of nursing and rehabilitative care. What<br>should you tell them about Original Medicare&#8217;s coverage of care in a skilled nursing facility?<br>\u2714\u2714Medicare will cover Mrs. Shield&#8217;s skilled nursing services provided during the first 20 days<br>of her stay, after which she would have a copay until she has been in the facility for 100 days.<br>Madeline Martinez was widowed several years ago. Her husband worked for many years and<br>contributed into the Medicare system. He also left a substantial estate which provides Madeline<\/p>\n\n\n\n<p>with an annual income of approximately $130,000. Madeline, who has only worked part-time for<br>the last three years, will soon turn age 65 and hopes to enroll in Original Medicare. She comes to<br>you for advice. What should you tell her? \u2714\u2714You should tell Madeline that she will be able to<br>enroll in Medicare Part A without paying monthly premiums due to her husband&#8217;s long work<br>record and participation in the Medicare system. You should also tell Madeline that she will pay<br>Part B premiums at more than the standard lowest rate but less than the highest rate due her<br>substantial income.<br>Mrs. West wears glasses and dentures and has enjoyed considerable pain relief from arthritis<br>through massage therapy. She is concerned about whether or not Medicare will cover these items<br>and services. What should you tell her? \u2714\u2714Medicare does not cover massage therapy, or, in<br>general, glasses or dentures.<br>Mrs. Quinn recently turned 66 and decided after many years of work to begin receiving Social<br>Security benefits. Shortly thereafter Mrs. Quinn received a letter informing her that she has been<br>automatically enrolled in Medicare Part B. She wants to understand what this means. What<br>should you tell Mrs. Quinn? \u2714\u2714Part B primarily covers physician services. She will be paying a<br>monthly premium and, with the exception of many preventive and screening tests, generally will<br>have 20% coinsurance for these services, in addition to an annual deductible.<\/p>\n\n\n\n<p>Mrs. Geisler&#8217;s neighbor told her she should look at her Part D options during the annual<br>Medicare enrollment period because features of Part D might have changed. Mrs. Geisler can&#8217;t<br>remember what Part D is so she called you to ask what her neighbor was talking about. What<br>could you tell her? \u2714\u2714Part D covers prescription drugs and she should look at her premiums,<br>formulary, and cost-sharing among other factors to see if they have changed.<br>Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has recently reviewed her<br>Medicare Summary Notice (MSN) and disagrees with a determination that partially denied one<br>of her claims for services. What advice would you give her? \u2714\u2714Mrs. Duarte should file an<br>appeal of this initial determination within 120 days of the date she received the MSN in the mail.<br>Mr. Rainey is experiencing paranoid delusions and his physician feels that he should be<br>hospitalized. What should you tell Mr. Rainey (or his representative) about the length of an<br>inpatient psychiatric hospital stay that Medicare will cover? \u2714\u2714Medicare will cover a total of<br>190 days of inpatient psychiatric care during Mr. Rainey&#8217;s entire lifetime.<br>Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs. Park<br>that might be of assistance? \u2714\u2714She should contact her state Medicaid agency to see if she<br>qualifies for one of several programs that can help with Medicare costs for which she is<br>responsible.<\/p>\n\n\n\n<p>Anita Magri will turn age 65 in August 2022. Anita intends to enroll in Original Medicare Part A<br>and Part B. She would also like to enroll in a Medicare Supplement (Medigap) plan. Anita&#8217;s<br>older neighbor Mel has told her about the Medigap Part F plan in which he is enrolled. It not<br>only provides foreign travel emergency benefits but also covers his Medicare Part B deductible.<br>Anita comes to you for advice. What should you tell her? \u2714\u2714You are sorry to disappoint Anita<br>but a Medigap Part F plan is no longer available to those who turn age 65 after January 1,2020.<br>Anita might instead consider other Medigap plans that offer foreign travel benefits but do not<br>cover the Part B deductible.<br>Ms. Henderson believes that she will qualify for Medicare Coverage when she turns 65, without<br>paying any premiums, because she has been working for 40 years and paying Medicare taxes.<br>What should you tell her? \u2714\u2714To obtain Part B coverage, she must pay a standard monthly<br>premium, though it is higher for individuals with higher incomes.<br>Mr. Alonso receives some help paying for his two generic prescription drugs from his employer&#8217;s<br>retiree coverage, but he wants to compare it to a Part D prescription drug plan. He asks you what<br>costs he would generally expect to encounter when enrolling into a standard Medicare Part D<br>prescription drug plan. What should you tell him? \u2714\u2714He generally would pay a monthly<br>premium, annual deductible, and per-prescription cost-sharing.<\/p>\n\n\n\n<p>AHIP FWA Questions and Answers with<br>Certified Solutions<br>Which of the following requires intent to obtain payment and the knowledge that the actions are<br>wrong? \u2714\u2714Fraud<br>Which of the following is NOT potentially a penalty for violation of a law or regulation<br>prohibiting Fraud, Waste, and Abuse (FWA)? \u2714\u2714Deportation<br>A person comes to your pharmacy to drop off a prescription for a beneficiary who is a &#8220;regular&#8221;<br>customer. The prescription is for a controlled substance with a quantity of 160. This beneficiary<br>normally receives a quantity of 60, not 160. You review the prescription and have concerns<br>about possible forgery. What is your next step? \u2714\u2714Call the prescriber to verify the quantity<br>Your job is to submit a risk diagnosis to the Centers for Medicare &amp; Medicaid Services (CMS)<br>for the purpose of payment. As part of this job you verify, through a certain process, that the data<br>is accurate. Your immediate supervisor tells you to ignore the Sponsor&#8217;s process and to<br>adjust\/add risk diagnosis codes for certain individuals. What should you do? \u2714\u2714Report the<br>incident to the compliance department (via compliance hotline or other mechanism<\/p>\n\n\n\n<p>AHIP general compliance questions and<br>answers already passed<br>Compliance is the responsibility of the compliance officer, compliance committee and upper<br>management only \u2714\u2714False<br>Ways to report a compliance issue include \u2714\u2714All of the above<br>What is the policy of non-retaliation \u2714\u2714Protects employees who, in good faith, report suspected<br>non-compliance<br>These are examples of issues that can be reported to a compliance department :suspected fraud,<br>waste, and abuse; potential health privacy violation and unethical behavior\/employee misconduct<br>\u2714\u2714True<br>Once a corrective action plan begins addressing non compliance or fraud, waste and abuse<br>committed by a sponsors employee or first tier, downstream, or related entity&#8217;s (fdr&#8217;s) employee,<br>ongoing monitoring or the corrective actions is not necessary \u2714\u2714False<br>Medicare parts c and d plan sponsors are not required to have a compliance program \u2714\u2714False<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Fraud, Waste, Abuse \u2013 1 (2022\/2023)Graded A+ACA Section 1557 differs from earlier legislation in providing broader protection againstdiscrimination based ona. disability.b. national origin.c. age.d. sex. \u2714\u2714dSection 1557 of the Affordable Care Act applies toa. all health programs and activities administered by or receiving federal financial assistancefrom HHS.b. Medicare Advantage plans only.c. all health programs and [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"categories":[25],"tags":[],"class_list":["post-116878","post","type-post","status-publish","format-standard","hentry","category-exams-certification"],"_links":{"self":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts\/116878","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/comments?post=116878"}],"version-history":[{"count":0,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts\/116878\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/media?parent=116878"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/categories?post=116878"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/tags?post=116878"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}