ATI-Health Care Fraud and Waste Abuse Graded A+

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Health Insurance Portability and Accountability Act (HIPPA) mandated that health care entities implement which of the following strategies to help reduce the Medicare fee-for-service error rate and pr... event payment for potential fraudulent activity? - ANSWER Answer: electronic health records Rationale: Electronic health records reduce the error of false claims. They are also more likely to be more thorough. Which of the following health care resources or services is most vulnerable to fraud, waste, and abuse? - ANSWER Answer: durable medical equipment Rationale: Durable medical equipment is the most vulnerable to abuse because providers can bill for high cost items the patients may not want or even need. Which of the following agencies of the U.S. government has the authority to exclude individuals and entities from participating in federal health care programs? - ANSWER Answer: Office of Inspector General (OIG) Rationale: The OIG has the authority to exclude individuals and entities from federal health care programs for fraud and abuse. Which of the following is an example of a best strategy to prevent fraud, waste, and abuse? - ANSWER Answer: establish a procedure for maintaining and distributing medication samples. Rationale: If your health care provider accepts free drug samples from manufacturers the best thing to do is ask about the procedures your facility has put in place to prevent fraud, waste and abuse Which piece of legislation mandated the establishment of a joint Health Care Fraud and Abuse Control (HCFAC) program? - ANSWER Answer: Health Insurance Portability and Accountability Act (HIPPA) Rationale: The HIPPA established the relationship between the U.S. Department of Health and Human Services Office of Inspector General. When an employee in a providers office suspects fraudulent activity and uses the Office of Inspector General (OIG) Hotline to report it, the employees should do which of the following? - ANSWER Answer: Stop filing suspicious bills, pursue knowledgeable legal counsel, disengage professionally, and report and return overpayments. According to recent estimates, which of the following sources of health care waste has had the largest financial impact? - ANSWER Answer: unwarranted use of medical resources or services Rationale: Unwarranted use of medical resources cost consumers a lot of money per year. [Show More]

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