Question 1

Ghost services are:

Accepted Answer

A) services designated so that maximum fees can be charged. 
B) procedures where one service is divided into many services and billed accordingly. 
C) services that never happened. 
D) hospital room charges that are reasonable but other charges are very high.

Question 2

Physicians are not the only ones involved in Medicare fraud. Investigators have recently been looking into services offered by:

Accepted Answer

A) chiropractors. 
B) physical therapists. 
C) massage therapists. 
D) pediatric dentists.

Question 3

Home care is a burgeoning business for scam artists. A company called Professional Care was paid for all of the following except:

Accepted Answer

A) work done by nonexistent workers. 
B) care for nonexistent patients. 
C) more hours than those provided. 
D) services done by untrained workers.

Question 4

Techniques that nursing homes use to keep patients cooperative include psychotropic substances.

Accepted Answer

A) True 
 B)False

Question 5

The phrase "cartel-type frauds" used in connection with health care refers to frauds perpetrated by:

Accepted Answer

A) passing patients from doctor to doctor. 
B) foreigners. 
C) a single central provider with thousands of patients. 
D) criminal organizations.

Question 6

Some argue that nursing home abuse occurs because of the vulnerability of its patients, the fact that the institutions are run for profit, and low pay for workers.

Accepted Answer

A) True 
 B)False

Question 7

The term "self-referral" stands for the practice of:

Accepted Answer

A) doctor selection of specialists and services based on financial connections. 
B) HMO selection of specialists and services based on providers in a network. 
C) insurance company selection of specialists and services based on low cost. 
D) patient selection of specialists and services based on recommendations from friends.

Question 8

Identify the various reasons Medicaid fraud does not receive much regulator or media attention. Analyze this in terms of the same aspects you would look at if this were a street crime. Why do you think some street crimes receive little attention?

Accepted Answer

The answer of Identify the various reasons Medicaid fraud does...

Question 9

Abuses in Medicaid may be worse than those in Medicare because it covers more services.

Accepted Answer

A) True 
 B)False

Question 10

Psychiatrists represent what percentage of all doctors suspended from Medicaid for fraudulent practices?

Accepted Answer

A) 10 
B) 25 
C) 30 
D) 20

Question 11

Services that are designated so that the maximum fees can be charged is called upcoding.

Accepted Answer

A) True 
 B)False

Question 12

___________ treatment accounts for 1/4 of all home infusion services, providing plenty of opportunity for would-be criminals.

Accepted Answer

A) Emphysema 
B) AIDS 
C) Cancer 
D) Kidney disease

Question 13

Doctors at a clinic at the University of California-Irvine abused fertility patients in all of the following ways except:

Accepted Answer

A) terminating pregnancies without patient consent. 
B) using unapproved fertility drugs. 
C) performing research on patients without their consent. 
D) stealing eggs and used them on other patients.

Question 14

What are self-referrals, and how do they constitute a conflict of interest for physicians?

Accepted Answer

The answer of What are self-referrals, and how do they...

Question 15

Certain public mental health facilities often face accusations of ________________.

Accepted Answer

The answer of Certain public mental health facilities often face...

Question 16

Excessive billing can take several forms. What are waivers?

Accepted Answer

A) Contracts for services that exceed Medicare limits. 
B) Patients giving up the right to question fees. 
C) Patients paying directly for services such as calls, refills, and conferences that Medicare considers covered. 
D) Up-front fees for services covered by Medicare supplemental policies.

Question 17

HMO selection of specialists and services based on providers in a network is referred to as "self-referral."

Accepted Answer

A) True 
 B)False

Question 18

Prominent universities and institutions have also been involved in Medicare/Medicaid fraud and abuse. Their activities include all of the following except:

Accepted Answer

A) $10 million in false Medicare claims. 
B) unnecessary lab tests. 
C) charging $18 separately for blood tests; private insurers paid 65 cents. 
D) not following guidelines and underpricing services.

Question 19

Nursing homes use psychotropic substances to keep ________________ cooperative.

Accepted Answer

The answer of Nursing homes use psychotropic substances to keep...

Question 20

In some instances, medical equipment is not only nonessential, but also ________________.

Accepted Answer

The answer of In some instances, medical equipment is not...

Exam 11: Medical Crime

Ghost services are:

Physicians are not the only ones involved in Medicare fraud. Investigators have recently been looking into services offered by:

Home care is a burgeoning business for scam artists. A company called Professional Care was paid for all of the following except:

Techniques that nursing homes use to keep patients cooperative include psychotropic substances.

The phrase "cartel-type frauds" used in connection with health care refers to frauds perpetrated by:

Some argue that nursing home abuse occurs because of the vulnerability of its patients, the fact that the institutions are run for profit, and low pay for workers.

The term "self-referral" stands for the practice of:

Identify the various reasons Medicaid fraud does not receive much regulator or media attention. Analyze this in terms of the same aspects you would look at if this were a street crime. Why do you think some street crimes receive little attention?

Abuses in Medicaid may be worse than those in Medicare because it covers more services.

Psychiatrists represent what percentage of all doctors suspended from Medicaid for fraudulent practices?

Services that are designated so that the maximum fees can be charged is called upcoding.

___________ treatment accounts for 1/4 of all home infusion services, providing plenty of opportunity for would-be criminals.

Doctors at a clinic at the University of California-Irvine abused fertility patients in all of the following ways except:

What are self-referrals, and how do they constitute a conflict of interest for physicians?

Certain public mental health facilities often face accusations of ________________.

Excessive billing can take several forms. What are waivers?

HMO selection of specialists and services based on providers in a network is referred to as "self-referral."

Prominent universities and institutions have also been involved in Medicare/Medicaid fraud and abuse. Their activities include all of the following except:

Nursing homes use psychotropic substances to keep ________________ cooperative.

In some instances, medical equipment is not only nonessential, but also ________________.