NSG 2360 ATI Health Care Fraud, Waste and Abuse Prevention – San Antonio college

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NSG 2360 ATI Health Care Fraud, Waste and Abuse Prevention – San Antonio college ATI Health Care Fraud, Waste and Abuse Prevention 1. When an employee in a provider’s office suspects fraudulen... t activity and uses the Office of Inspector General (OIG) Hotline to report it, the employee should do which of the following? (The employee should stop filing the problematic bills immediately to avoid additional fraud.) While the Qui Tam statute forbids employers from harassing or retaliating against an employee for reporting fraud, the employee must prepare to deal with such issues. Sources of support and protection, such as having a legal representative, may help with this process. (For the employee’s personal safety, the recommendation after reporting suspected fraud is to disengage professionally from the person the employee reported to whatever extent is possible in the situation.) (The employee should determine what money was collected in error from patients and from the federal health care programs and report and return overpayments.) 2. Which piece of legislation mandated the establishment of a joint Health Care Fraud and Abuse Control (HCFAC) program? 3. Health Insurance Portability and Accountability Act (HIPAA) mandated that health care entities implement which of the following strategies to help reduce the Medicare fee-for-service error rate and prevent payment for potential fraudulent activity? 4. Which of the following agencies of the US government has the authority to exclude individuals and entities from participating in federal health care programs? 5. Which of the following is an example of a best practice strategy to prevent fraud, waste and abuse? 6. Which of the following health care resources or services is most vulnerable to fraud, waste and abuse? 7. According to recent estimates, which of the following sources of health care waste has had the largest financial impact? [Show More]

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