TEST: FRAUD, WASTE, AND ABUSE (FWA)

This test consists of 10 True or False questions. To make an answer selection, simply click on the circle next to the response. When finished, click the "Grade Test" button to receive your score. If necessary, you may click the "Start Over" button to reset the exam. A score of 100% is required.


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1. The purpose of a compliance plan and annual training for health care facility staff is to preclude incidences of Fraud, Waste and Abuse associated with the payment of medical services by Medicare and Medicaid. 2. Fraud is a more significant issue, and more care should be given to fraudulent activities as opposed to Waste or Abuse. 3. Health Care Abuse involves payments for items or services when there is no legal entitlement to that payment and the provider has not knowingly and/or intentionally misrepresented facts to obtain payment. 4. Medical Record documentation is critical in supporting the appropriateness of a claim and avoiding any allegations of FWA. 5. Anyone who participates in the provision of the Part D benefit program, either through client interaction, medication dispensing, or claims preparation should receive FWA training. 6. Persons administering or delivering Part D benefits are required to be free from any conflict(s) of interest in the provision of such benefit and, an attestation indicating this should be kept on file and updated annually. 7. Medication claims may be denied for payment if the refill is too early to fill and is submitted to the third party for payment. 8. A complete Compliance plan must encompass these eight areas:
- 1. Written Policies and Procedures, Standards of Conduct"
- 2. Compliance Officer & Compliance Committee
- 3. Training & Education
- 4. Effective lines of communication
- 5. Enforcement of Standards through well publicized disciplinary guidelines
- 6. Monitoring & Auditing
- 7. Corrective Action Procedures
- 8. Procedures to voluntarily self report potential fraud or misconduct. 9. Allegations of ABUSE are limited to the intentional:
- a. Charging in excess for services or supplies
- b. Submitting bills to Medicare that are the responsibility of other payers
- c. Billing for services that do not meet professionally recognized standards 10. Audits by CMS in order to determine compliance with Part D contract regulations can include all of the following:
- a. Copies of prescriptions
- b. Invoices
- c. Pharmacy licenses
- d. Claims records
- e. Conflict of Interest Statements
- f. Signature logs
- g. Interviews with staff

Once you have scored 100%, A BUTTON WILL APPEAR BELOW which generates your Certificate of Completion to add to your personnel file.


Virginia Department Of Behavioral Health And Developmental Services - Version 1.0 - 07/01/09