How often must a corrective action plan be monitored?
This quiz is incomplete! To play this quiz, please finish editing it. This quiz is incomplete! To play this quiz, please finish editing it. Once a corrective action plan is started, the corrective actions must be monitored annually to ensure they are effective.
Do kickbacks count as Medicare fraud?
Bribes or kickbacks of any kind for services that are paid under a federal health care program (which includes medicare) constitute fraud by the person making as well as the person receiving them. True
What is Medicare fraud management training?
The Centers for Medicare and Medicaid Services (CMS) requires annual fraud, waste, and abuse training for organizations providing health, prescription drug, or administrative services to Medicare Advantage (MA) or Prescription Drug Plan (PDP) enrollees on behalf of a health plan.
What are the consequences of false claims in Corrective Action?
All of the above Once a corrective action plan is started, the corrective actions must be monitored annually to ensure they are effective. Any person who knowingly submits false claims to the Government is liable for five times the Government's damages caused by the violator plus a penalty.
What are some of the penalties for violating fraud waste and abuse FWA laws select the best answer?
Penalties include fines up to $25,000, imprisonment for up to 5 years and exclusion from Federal Health Care Programs (e.g., Medicaid & Medicare).
How do you report potential fraud waste and abuse FWA )? Select the correct answer and click submit?
Fraud, Waste and Abuse (FWA)Fraud Hotline: 1-800-488-0134 (Follow the prompts for reporting Fraud)Written Report: Use the Fraud, Waste and Abuse Reporting Form on www.caresource.com or write a letter and send to:
What are examples of issues that should be reported to compliance department?
These are examples of issues that can be reported to a Compliance Department: suspected Fraud, Waste, and Abuse (FWA); potential health privacy violation, and unethical behavior/employee misconduct.
What are the ways to report potential fraud waste and abuse?
There are several ways to contact the Hotline:Toll-free phone: 1-800-HHS-TIPS (1-800-447-8477), 8:00 am - 5:30 pm, Eastern Time, Monday-Friday.Fax: 1-800-223-8164 (10 pages or less, please)TTY: 1-800-377-4950.Mail: HHS TIPS Hotline. P.O. Box 23489. Washington, DC 20026. (Note: please do not send any original documents)
How often should a corrective action plan be monitored to ensure they are effective?
Once a corrective action plan is started, the corrective actions must be monitored annually to ensure they are effective. Any person who knowingly submits false claims to the Government is liable for five times the Government's damages caused by the violator plus a penalty.
What is FWA fraud waste abuse?
Fraud is lying with the knowledge that the lie could result in a benefit to someone. Waste and Abuse are practices that result in unnecessary cost to health programs, or payment for services that are not medically necessary.
How many core compliance requirements are mandated by CMS?
seven core requirementsOrganizations must create and maintain compliance programs that, at a minimum, meet the seven core requirements.
What is Medicare compliance?
The Medicare Compliance Program is specifically designed to prevent, detect, and correct noncompliance as well as fraud, waste, and abuse.
What does internal monitoring of compliance ensure?
Compliance monitoring is there to ensure your organization complies with the necessary rules, regulations, policies, laws, and standards that guide your organization.
What resources are available to report actual or potential Medicare compliance fraud waste or abuse?
Reports of potential non-compliance or FWA can be made to the CVS Caremark Part D Services' Fraud, Waste and Abuse Program by email at [email protected], by calling the Fraud, Waste and Abuse Hotline at 1-888-277-4149 or anonymously by calling the CVS Health Ethics line at 1-877-CVS-2040.
Which of the following requires intent to obtain payment and the knowledge of actions are wrong quizlet?
Fraud requires intent to obtain payment and the knowledge the actions are wrong. Waste and abuse may involve obtaining an improper payment or creating an unnecessary cost to the Medicare Program but do not require the same intent and knowledge.
How do I report to CMS?
How to File a Complaint.CMS, on behalf of HHS, enforces HIPAA Administrative Simplification requirements.Go to ASETT.CMS.GOV.Upon logging in, click the "New Complaint" button on the welcome page.Click “Complaint Type” and select the issue you are reporting.More items...
What is the difference between preventive and corrective action?
While both intend to address non-conformance, there are some differences between corrective and preventive action. Corrective Action. Preventive Action. Considered the “reactive” way of addressing non-conformance. “Proactive” way of addressing non-conformance.
Why is corrective action important?
A corrective action plan is important because it serves as a proper documentation of the corrective actions an organization has taken. By developing a corrective action plan, quality managers, site supervisors, and team leaders can make sure that corrective actions are carried out and monitored effectively.
What is Medicare fraud and abuse training?
The Centers for Medicare and Medicaid Services (CMS) requires annual fraud, waste, and abuse training for organizations providing health, prescription drug, or administrative services to Medicare Advantage (MA) or Prescription Drug Plan (PDP) enrollees on behalf of a health plan.
When was the False Claims Act enacted?
The False Claims Act, or FCAwas enacted in 1863 to fight procurement fraud in the Civil War. The FCA has historically prohibited knowingly presenting or causing to be presentedto the federal government a false or fraudulent claim for payment or approval.
What is misrepresenting personal information?
Misrepresenting personal information by: Sharing a beneficiary ID card Falsifying identity, eligibility, or medical condition in order to illegally receive the drug benefit Attempting to use the enrollee identity card to obtain prescriptions when the enrollee is no longer covered under the drug benefit.
What is the GSA exclusion list for Medicare Advantage?
Medicare Advantage Organizations, Part D Sponsors and contracted entities are required to check the OIG and General Services Administration (GSA) exclusion lists for all new employees and at least once a year thereafter to validate that employees and other entities that assist in the administration or delivery of services to Medicare beneficiaries are not included on such lists.