Question 1
Are Medicare Parts C and D plan Sponsors required to have a compliance program?
Correct Answer:
False
Explanation:
Medicare Parts C and D sponsors are expected to have strong controls to prevent fraud, waste, and abuse, but there isn’t a statutory or regulatory mandate that every sponsor must operate a formal, written compliance program. Guidance from CMS and the OIG outlines what an effective compliance program should include—written policies and procedures, a designated compliance officer, ongoing training, monitoring and auditing, enforcement with corrective actions, and procedures for investigations and open reporting. Since the requirement to have a formal compliance program isn’t explicitly imposed by law or regulation, the statement is not correct. That said, implementing a formal program aligns with CMS expectations and helps reduce risk, support program integrity, and improve oversight.
Question 2
Which statement is most accurate about responsibility for compliance?
Correct Answer:
It is a shared responsibility across all employees
Explanation:
Compliance is a collective obligation. While the Compliance Officer leads the program—establishing policies, providing training, monitoring activities, and guiding corrective action—the daily success of compliance hinges on every employee’s actions. When everyone understands policies, follows established procedures, and feels empowered to speak up about concerns, the organization creates a culture that deters fraud, waste, and abuse and reduces risk. Regulators enforce rules and can hold the organization accountable, and vendors must meet contractual requirements, but the ultimate responsibility for staying compliant rests with the organization and its people at all levels.
Question 3
Which statement best describes the role of standards of conduct in Medicare Parts C and D sponsor operations?
Correct Answer:
They define the expected behavior of employees
Explanation:
Standards of conduct establish the baseline for how everyone in the sponsor should behave to stay in compliance with Medicare rules and to prevent fraud, waste, and abuse. In Medicare Parts C and D operations, they communicate the ethical and legal expectations to all employees and contractors, guiding daily decisions, training, and how issues are investigated and addressed. They aren’t laws themselves, but internal requirements that carry real consequences if violated, and they apply across the organization, not just to top management. That’s why defining the expected behavior of employees best captures their purpose.
Question 4
What is the role of language assistance under ACA Section 1557?
Correct Answer:
Must be provided at no cost
Explanation:
Under ACA Section 1557, language assistance ensures meaningful access to health services for people with limited English proficiency or disabilities. This means providing interpreters for spoken language, translating vital written materials, and offering accessible formats so patients can understand and participate in their care. These services must be provided at no cost to the patient. It is not optional, nor is it limited to emergencies or to written communications alone. Facilities should use qualified interpreters rather than relying on family members or minors. In short, the role is to remove language and disability barriers to equal access in health care by offering free language and accessibility services.
Question 5
Which practice involves billing for higher service or item codes than those actually performed?
Correct Answer:
Upcoding
Explanation:
Upcoding is billing for a higher-cost code than the service actually performed. In medical coding, each service has a code that reflects its complexity, time, and resources used. When a provider uses a more expensive code than what was delivered, the payer pays more than warranted. This intentional misrepresentation is a form of fraudulent billing and can lead to audits, repayment of funds, and penalties. For context, unbundling would involve billing separate components that should be covered by a single code, which is a different improper practice; kickbacks relate to improper payments for referrals, not the coding itself. So the described practice is upcoding.
Question 1
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Prepare with the Fraud, Waste, and Abuse (FWA) 2 Practice Exam practice quiz. This question bank includes 10 questions covering payment, medicare, parts, compliance, and describes. Use it to review important concepts, identify knowledge gaps, and build confidence for the related exam, course, or assessment.

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Fraud, Waste, and Abuse (FWA) 2 Practice Exam

This practice set contains 10 questions from the matching question bank and focuses on payment, medicare, parts, compliance, and describes. Work through each question carefully, review the provided solutions, and revisit topics that need more study before your next attempt.

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