PQA Provider Education: Legal Issues for Medical Clinics (02/26/2025)

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* 1. Contact Information

Name *

Practice and Job Title *

Work Email Address *

Work Phone Number

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* 2. (True or False) The Government can put clinics under Payment Suspension, meaning clinics will not be paid for any Medicare or other Government program, when there is a credible suspicion and not yet proof that the clinic has committed fraudulent billing.

True

False

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* 3. The average length of time to resolve a billing problem after a Payment Suspension has been imposed on a clinic is:

2 months

4 months

6 months

8 months

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* 4. What agencies can audit clinics for billing fraud?

Office of Inspector General (OIG)

Federal Bureau of Investigation (FBI)

Centers for Medicare and Medicaid Services (CMS)

Recovery Audit Contractors (RACs)

Commercial Payer

A, B, and C

All of the above

None of the above

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* 5. What are potential consequences of fraudulent billing for medical clinics and their providers?

Limitation or loss of medical license

Pay back to the government 3 times the damages.

Become ineligible to participate in MC, Medicaid, Tricare or another governmental program

Prison

All of the above

None of the above

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* 6. (True of False) According to the False Claims Act of 1863, if you accidentally overbill Medicare for a patient’s health care you have committed fraud.

True

False

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* 7. Education Feedback: Please let us know if this session was helpful and how we can improve. Also, please let us know of any topics you would appreciate us presenting in future sessions.