1
ATI: Health Care Fraud, Waste, and
Abuse Prevention Pretest Questions and Answers | Latest Version | 2025/2026 | Correct & Verified
What is the definition of health care fraud?✔✔Health care fraud is the intentional deception or misrepresentation of services for personal or financial gain.
What is an example of waste in health care?✔✔Ordering unnecessary diagnostic tests or procedures that do not improve patient outcomes.
What action should a nurse take if they suspect fraudulent billing practices?✔✔Report the concern to a compliance officer or use the facility’s anonymous reporting system.
Why is it important to prevent abuse in health care billing?✔✔Because abuse can lead to increased costs, strained resources, and reduced trust in the health care system.
- / 2
2
What is one consequence of knowingly participating in fraudulent activity?✔✔Civil or criminal penalties, including fines or imprisonment.
How can a nurse help reduce waste in documentation?✔✔By accurately recording only the care that was provided and avoiding duplication.
What is the difference between fraud and abuse in health care?✔✔Fraud is intentional deception, while abuse involves actions that may be inappropriate but not intentionally misleading.
What is an example of abuse in a clinical setting?✔✔Billing for a higher level of care than was actually provided, even without malicious intent.
How can facilities promote ethical billing practices?✔✔By providing regular training on coding standards and auditing billing processes.
Why should staff avoid upcoding services?✔✔Because it falsely increases reimbursement and is considered fraudulent billing.
- / 2