Fraud Awareness Test

Answers at the bottom

1. What is the estimated loss due to healthcare fraud and abuse annually in the United States?
   1. Less than $100 million
   2. Approximately $300
   3. Approximately $60
   4. More than $200 billion

2. Healthcare fraud is a high priority for the United States Department of Justice.
   1. True
   2. False

3. A Pharmacy may submit a claim to an insurance company for filling a prescription, even if the patient forgets to retrieve it from the Pharmacy.
   1. True
   2. False

4. Which of the following is not healthcare fraud?
   1. A health insurance subscriber lets an un-approved person use their insurance identification card to obtain health benefits.
   2. A doctor consults with a patient for 35 minutes, and submits a claim to the patient's insurance company for a 60 minute consultation.
   3. A hospital submits claims to a patient's insurance company for services it provided to the patient on July 4th.
   4. None of the above

5. Healthcare fraud is a victimless crime.
   1. True
   2. False

Answers:

1. C. The National Health Care Anti-fraud Association estimates it to be about 3 percent of the overall healthcare costs leading to losses of nearly $60 billion annually.
2. True.
3. False. A Pharmacy is only entitled to payment if a patient receives the product.
4. C. There is nothing improper for submitting a claim for services on any Holiday, as long as the patient was there and received the services.
5. False.
• In some extreme cases, a patient's good health has been compromised by the provision of unnecessary, invasive procedures, just to obtain insurance payments.
• As a general rule, healthcare fraud causes insurance premiums and other associated costs to rise for everyone.