HCAFA — Health Care Anti-Fraud Associate Healthcare Practice Questions

During an audit, 10% of a healthcare provider's claims are found to be fraudulent. What step should be taken first?

• AA. Conduct further investigation
• BB. Change the billing process
• CC. Increase the provider's payments
• DD. Notify all patients

A healthcare organization noticed a pattern of excessive billing for a specific procedure. What is the most appropriate response?

• AA. Notify patients about potential fraud
• BB. Increase the budget for the procedure
• CC. Ignore the pattern
• DD. Review and investigate

A healthcare provider provides unnecessary services for the purpose of billing. What is this an example of?

• AA. Upcoding
• BB. Fraud
• CC. Systematic care
• DD. Patient misrepresentation

A new policy is introduced to tackle healthcare fraud. What is the critical element for its success?

• AA. Increased patient billing
• BB. Strong training for employees
• CC. Strict penalties for patients
• DD. Limiting provider contracts

A coding error leads to an overpayment to a healthcare provider. What action should be taken?

• AA. Ignore it
• BB. Increase future claims
• CC. Recover the overpayment
• DD. Write off the overpayment