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Health Care Fraud, Waste and Abuse Prevention Questions and Answers | Latest Version | 2025/2026 | Correct & Verified
A provider submits claims for patients they have never seen. What is this called?✔✔ This is healthcare fraud.
A nurse falsifies time spent with patients to receive higher reimbursement. What is this?✔✔ This is considered fraud through time inflation.
A patient receives a bill for services done on a holiday when the clinic was closed. What does this suggest?✔✔ Possible fraudulent billing.
Why is healthcare abuse harmful even if it's unintentional?✔✔ It still wastes resources and inflates healthcare costs.
A billing clerk routinely enters incorrect procedure codes. What is this an example of? 1 / 2
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✔✔ This is considered waste or possibly abuse if it leads to overpayment.
A doctor bills a more expensive test than what was provided. What is that called?✔✔ Upcoding, which is a form of healthcare fraud.
A receptionist notices a provider submitting the same diagnosis code for every patient. What should they do?✔✔ Report the suspicious pattern to the compliance officer.
How can employees avoid contributing to healthcare abuse?✔✔ By following documentation policies and only billing for necessary services.
Why is “double billing” considered fraud?✔✔ It results in being paid twice for the same service.
What is an example of kickback in healthcare?✔✔ A provider receiving money for referring patients to a specific facility.
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