Medicare Compliance & Reimbursement

Find out where you stand on these regulations.

To avoid federal scrutiny and the watchful eye of the government, you and your staff must promote a culture of compliance, adopting high standards, submitting clean claims, and protecting patients.

One of the best ways to do that is to ensure your workforce knows and understands the major fraud and abuse laws that impact Medicare providers. Measure your staff’s smarts with this handy quiz on the fundamental elements of fraud, abuse, and enforcement.

1. What is the technical term for any acceptance of reward, incentive, or payment for a referral?

A. Willful neglect

B. Kickback

C. Standard

D. Billing requirement

2. What law is commonly referred to as the “Stark Law?”

A. Anti-Kickback Statute (AKS)

B. False Claims Act (FCA)

C. Physician Self-Referral Law

D. Civil Monetary Penalties Law (CMPL)

3. Which of the following credentials qualifies someone as a physician, in terms of the Stark Law?

A. Medical doctor (MD)

B. Doctor of osteopathy (DO)

C. Dentist (DDS)

D. All of the above, plus podiatrist (DPM), optometrist (OD), and chiropractor (DC)

4. Which of the following does not qualify as a designated health service (DHS)?

A. Clinical laboratory services

B. Physician professional services

C. Physical, occupational, and speech language therapy

D. Radiation therapy

5. What could constitute a false claim under the False Claims Act?

A. Unbundling

B. Upcoding

C. Double-billing

D. All of the above

6. What database should practice managers check often to see if their employees or business partners have been excluded from participating in federal healthcare programs like Medicare or Medicaid?

A. CMS provider data catalog

B. OCR breach portal

C. OIG list of excluded individuals/entities (LEIE)