HCAFA — Health Care Anti-Fraud Associate Provider Practice Questions

A provider submits a claim for a procedure that was never performed. What should be the primary action taken?

• AA. Review the patient's record
• BB. Report to the insurance company
• CC. Pay the claim promptly
• DD. Increase the provider's reimbursement

A patient receives a bill for a service they did not receive but confirms the provider's details were accurate. What is the likely cause?

• AA. Provider error
• BB. Billing error
• CC. Patient error
• DD. Insurance error

If an investigation reveals collusion between a provider and a billing company, what is likely the next step?

• AA. Decrease payments
• BB. Terminate the provider's contract
• CC. Continue business as usual
• DD. Notify patients