Medicare
Another name for Medicare.
What is CMS, Centers for Medicare & Medicaid Services?
Practices that result in unnecessary Medicare costs.
What is Waste as defined by CMS?
Dr. Smith has ordered 3 MRIs for the same area and same complaint.
What is an example of Waste?
Names, addresses, phone numbers, SSNs, for example.
What are examples of PHI?
Makes financially rewarding referrals a crime.
What is the Anti-Kickback Statute?
$2,140 per calendar year.
What is the annual Medicare threshold for combined PT and SLP services?
Knowingly submitting false claims for federal payment.
What is Fraud, as defined by Medicare?
Dr. Smith receives $50 for every referral he sends to Hoku.
What is an example of Fraud?
Health care providers, health care clearinghouses, and health insurance providers.
Makes a person liable for submitting untrue claims to gain financial benefit from the Gov.
What is the False Claims Act?
Code used to attest to the medical necessity when charges exceed threshold.
Practice that provides unnecessary or substandard Medical services.
What is Abuse as defined by Medicare?
Hoku billed for individual services instead of group services because it pays more.
What is an example of Medicare Abuse or Fraud?
Emailing personal information to the wrong patient.
What is an example of HIPAA violation?
Allows the Gov. to pursue financial repayment.
What is the Civil Monetary Penalties Law?
Designed to minimize government expense.
What is the purpose of FWA rules?
Kickbacks, bribes or rebates, for example.
What are examples of Fraud?
Dr. Smith instructed her patient to return weekly for check ups for a hangnail.
What is an example of Medicare Waste?
$141-2M per violation.
What is the financial penalty range for HIPAA violations?
Prohibits MDs from referring to family members for financial gain.
What is the Stark Law?
Documentation review for some cases exceeding $3,000.
What is the Targeted Medicare Review?
Intent is required for this type of infraction.
What is Fraud?
Mr. Johnson canceled his last 3 appointments but Hoku billed for the visits anyway.
What is an example of Medicare Fraud?
What is a real life example of a HIPAA violation?
Disallows convicted parties from participating in Medicare/ Medicaid programs.
What is the Exclusion Statute?