Deck 11: Medical Crime

Question 1

American dialysis patients are how many times more likely to die in a given year as those in Western Europe or Japan?

A)5
B)4
C)2
D)3

Answer 1

C

Question 2

Medicare is an easy mark for fraudulent equipment sales because:

A)of failure to account for the legitimacy of suppliers.
B)no check is made on patient eligibility.
C)no check is made on the qualifications of doctors.
D)no verifications are made of patient conditions.

Answer 2

A

Question 3

The term "self-referral" stands for the practice of:

A)doctor selection of specialists and services based on financial connections.
B)HMO selection of specialists and services based on providers in a network.
C)insurance company selection of specialists and services based on low cost.
D)patient selection of specialists and services based on recommendations from friends.

Answer 3

A

Question 4

Boiler rooms with slick telemarketers offered full physicals for a little or no fee. This free diagnostic service turned out to be very costly because:

A)information was used to file claims against insurance companies and government insurance.
B)patients were pushed to take out loans to cover services.
C)patients' credit card information was obtained and card companies were billed.
D)patients were required to furnish bank information and electronic checks were processed by financial institutions.

Question 5

In some instances the equipment is not only nonessential, it is also:

A)outdated.
B)defective.
C)harmful.
D)overpriced.

Question 6

Home care is a burgeoning business for scam artists. A company called Professional Care was paid for all of the following except:

A)work done by nonexistent workers.
B)care for nonexistent patients.
C)more hours than those provided.
D)services done by untrained workers.

Question 7

Upcoding is:

A)hospital room charges that are reasonable but other charges are very high.
B)a procedure where one service is divided into many services and billed accordingly.
C)services that never happened.
D)services designated so that maximum fees can be charged.

Question 8

What Houston school personnel have been offered rewards to refer troubled students?

A)Assistant principals
B)Teachers
C)Counselors
D)Nurses

Question 9

___________ treatment accounts for 1/4 of all home infusion services, providing plenty of opportunity for would-be criminals.

A)Emphysema
B)AIDS
C)Cancer
D)Kidney disease

Question 10

Excessive billing can take several forms. What are retainers?

A)Patients paying directly for services such as calls, refills, and conferences that Medicare considers covered.
B)Contracts for services that exceed Medicare limits.
C)Up-front fees for services covered by Medicare supplemental policies.
D)Patients giving up the right to question fees.

Question 11

Prominent universities and institutions have also been involved in Medicare/Medicaid fraud and abuse. Their activities include all of the following except:

A)$10 million in false Medicare claims.
B)unnecessary lab tests.
C)charging $18 separately for blood tests; private insurers paid 65 cents.
D)not following guidelines and underpricing services.

Question 12

The ripple effect of false medical diagnoses to get money includes which of the following?

A)Negative credit card history created
B)People denied jobs
C)People unable to get life insurance
D)People unable to get bonding necessary for particular jobs

Question 13

The phrase "cartel-type frauds" used in connection with health care refers to frauds perpetrated by:

A)passing patients from doctor to doctor.
B)foreigners.
C)a single central provider with thousands of patients.
D)criminal organizations.

Question 14

Doctors referring patients to labs and other institutions in which they have partial ownership is problematic for all of the following reasons except:

A)conflict of interests.
B)higher prices.
C)failure to make a referral if it is no benefit to doctor.
D)unnecessary referrals.

Question 15

Unbundling is:

A)services designated so that maximum fees can be charged.
B)a procedure where one service is divided into many services and billed accordingly.
C)hospital room charges that are reasonable but other charges are very high.
D)services that never happened.

Question 16

Excessive billing can take several forms. What are waivers?

A)Contracts for services that exceed Medicare limits.
B)Patients giving up the right to question fees.
C)Patients paying directly for services such as calls, refills, and conferences that Medicare considers covered.
D)Up-front fees for services covered by Medicare supplemental policies.

Question 17

Ghost services are:

A)services designated so that maximum fees can be charged.
B)procedures where one service is divided into many services and billed accordingly.
C)services that never happened.
D)hospital room charges that are reasonable but other charges are very high.

Question 18

Bounty hunters in the medical fraud area are:

A)people who use strong-arm tactics to collect bills that are not owed.
B)doctors who receive a fee for a particular diagnosis.
C)facilities that specialize in the patients who are most seriously ill.
D)people who collect a fee for patient referral.

Question 19

Equipment sales frauds work for all of the following reasons except:

A)doctors' signatures are forged.
B)Medicare does not review doctors' credentials.
C)patients pressure doctors to sign forms.
D)corrupt doctors.

Question 20

Health Maintenance Organizations (HMOs) are the new model for providing medical care. Criticisms of HMOs include all of the following except:

A)big salaries for administrators.
B)overemphasis on profit instead of care.
C)multiple trips to many specialists.
D)negligent under-treatment.

Question 21

HMO selection of specialists and services based on providers in a network is referred to as "self-referral."

Question 22

Some argue that nursing home abuse occurs for all of the following reasons except:

A)the vulnerability of its patients.
B)unreasonable expectations of family members.
C)institutions are run for profit.
D)low pay for workers.

Question 23

Cost-shifting is where hospital room charges are reasonable, but other charges are very high.

Question 24

What percentage of doctors barred by the Medicare program are not penalized by the state medical boards?

A)20
B)25
C)50
D)30

Question 25

Doctors at a clinic at the University of California-Irvine abused fertility patients in all of the following ways except:

A)terminating pregnancies without patient consent.
B)using unapproved fertility drugs.
C)performing research on patients without their consent.
D)stealing eggs and used them on other patients.

Question 26

The case of Dr.Jose Manaya was described by shocking the judge who sentenced him. He performed unnecessary ____________ on patients.

A)dialysis
B)appendectomies
C)cataract surgery
D)gallbladder surgery

Question 27

Bounty hunters in the medical fraud area are doctors who receive a fee for a particular diagnosis.

Question 28

Boiler rooms with slick telemarketers offered full physicals for little or no fee. This free diagnostic service turned out to be very costly because patients were required to furnish bank information and electronic checks were processed by financial institutions.

Question 29

Abuses in Medicaid may be worse than those in Medicare because it covers more services.

Question 30

Psychiatrists represent what percentage of all doctors?

A)2
B)8
C)15
D)20

Question 31

Physicians are not the only ones involved in Medicare fraud. Investigators have recently been looking into services offered by:

A)chiropractors.
B)physical therapists.
C)massage therapists.
D)pediatric dentists.

Question 32

Dr.Olga Romani was involved in all of the following except:

A)the disfiguring of an acne patient.
B)billing for 165 visits for a patient she had never seen.
C)the murder of her partner.
D)she refused to treat a patient for diaper rash.

Question 33

Psychiatrists represent what percentage of all doctors suspended from Medicaid for fraudulent practices?

A)10
B)25
C)30
D)20

Question 34

Fragmentation is where a number of charges can be made from what is usually one single less-expensive charge for services or procedures.

Question 35

The phrase "cartel-type frauds" used in connection with health care are frauds perpetrated by criminal organizations.

Question 36

One investigator states that catching people who defraud Medicare is like catching fish that jump into the boat. Why would he say this?

A)Only those who treat the most patients get caught.
B)Only repeat offenders get caught.
C)Only those who make the most money get caught.
D)Only the stupid and reckless get caught.

Question 37

Contracts that exceed Medicare limits are called overcharging.

Question 38

Which of the following activities could constitute research fraud?

A)Adjusting findings to support grant applications
B)Using animals to test harmful drugs
C)Not reporting findings
D)Taking grant money for questionable biological research

Question 39

Medicare can be an easy mark for fraudulent equipment sales because it often fails to account for the legitimacy of suppliers.

Question 40

Services that are designated so that the maximum fees can be charged is called upcoding.

Question 41

Patient referral firms are known as ________________.

Question 42

Techniques that nursing homes use to keep patients cooperative include psychotropic substances.

Question 43

Psychiatrists represent 20% of all doctors suspended from Medicaid for fraudulent practices.

Question 44

Certain public mental health facilities often face accusations of ________________.

Question 45

In some instances, medical equipment is not only nonessential, but also ________________.

Question 46

Psychiatrists represent ________________ % of all doctors.

Question 47

Explain why the incidence of home care fraud has increased. What forms does it take and why is this crime difficult to investigate?

Question 48

Using animals to test harmful drugs would be an activity that could constitute research fraud.

Question 49

What are self-referrals, and how do they constitute a conflict of interest for physicians?

Question 50

Describe how fraud can be committed in medical equipment sales. What are the dangers for the public when this occurs?

Question 51

An item that millions use every day that makes it easier to catch psychiatrists in wrongdoing is a wristwatch.

Question 52

Identify and describe the three most common billing irregularities in physician Medicare fraud.

Question 53

________________ services are services that never happened.

Question 54

________________ are up-front fees for services covered by Medicare supplemental policies.

Question 55

Cecil Jacobson operated a ________________ clinic that hurt patients by using his own sperm for fertilization without patient knowledge and using hormones to convince women they were pregnant when they were not.

Question 56

What is fertility fraud? Discuss how is victimized and how they are victimized.

Question 57

Nursing homes use psychotropic substances to keep ________________ cooperative.

Question 58

Some argue that nursing home abuse occurs because of the vulnerability of its patients, the fact that the institutions are run for profit, and low pay for workers.

Question 59

Despite or perhaps because of the Anti-Fraud Anti-Abuse Amendments of 1977 Medicaid fraud has grown more ________________.

Question 60

Identify the various reasons Medicaid fraud does not receive much regulator or media attention. Analyze this in terms of the same aspects you would look at if this were a street crime. Why do you think some street crimes receive little attention?

Question 61

How effective is the medical profession at policing itself? Give specific examples for your answers. What changes do you think would be needed to improve accountability in the profession?