an action that results in unnecessary costs to a federal healthcare program, either directly or indirectly

Conditions of Participation (CoP)

conditions that healthcare organizations must meet to participate with the plan or program

According to HIPAA, defined as health plans, healthcare clearinghouses , and healthcare providers who electronically transmit any health information in connection with transactions for which HHS has adopted standards

False Claims Act (FCA)

federal statute setting criminal and civil penalties for falsely billing the government, over representing the amount of a delivered product, or understating an obligation to the government

making false statements or misrepresenting facts to obtain an undeserved benefit or payment from a federal healthcare program

Health Insurance Portability and Accountability Act (HIPAA)

federal law in which the primary goal is to make it easier for people to keep health insurance, protect the confidentiality and security of health information, and help the healthcare industry control administrative costs.

Preferred Provider Organization (PPO)

managed care organization of medical doctors, hospitals and other healthcare providers who have agreed with an insurer or a third party administrator to provide healthcare at reduced rates to the insurers or administrators clients

Protected Health Information (PHI)

individually identifiable health information that include many common identifiers, such as demographic data, name, address, birthdate, and social security number. it also includes information that relates to an individuals past, present or future physical

a lawsuit brought by a private citizen against a person or company wo is believed to have violated the law in the performance of a contract with the government or in violation of a government regulation , when there is a statute which provides for a penal

Truth in Lending Act (TILA)

designed to assure that every customer who needs consumer credit is giving meaningful information concerning the cost of such credit

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Question	Answer
Abuse	an action that results in unnecessary costs to a federal healthcare program, either directly or indirectly
Conditions of Participation (CoP)	conditions that healthcare organizations must meet to participate with the plan or program
Covered entity	According to HIPAA, defined as health plans, healthcare clearinghouses , and healthcare providers who electronically transmit any health information in connection with transactions for which HHS has adopted standards
False Claims Act (FCA)	federal statute setting criminal and civil penalties for falsely billing the government, over representing the amount of a delivered product, or understating an obligation to the government
Fraud	making false statements or misrepresenting facts to obtain an undeserved benefit or payment from a federal healthcare program
Health Insurance Portability and Accountability Act (HIPAA)	federal law in which the primary goal is to make it easier for people to keep health insurance, protect the confidentiality and security of health information, and help the healthcare industry control administrative costs.
Preferred Provider Organization (PPO)	managed care organization of medical doctors, hospitals and other healthcare providers who have agreed with an insurer or a third party administrator to provide healthcare at reduced rates to the insurers or administrators clients
Protected Health Information (PHI)	individually identifiable health information that include many common identifiers, such as demographic data, name, address, birthdate, and social security number. it also includes information that relates to an individuals past, present or future physical
Qui tam Action	a lawsuit brought by a private citizen against a person or company wo is believed to have violated the law in the performance of a contract with the government or in violation of a government regulation , when there is a statute which provides for a penal
Truth in Lending Act (TILA)	designed to assure that every customer who needs consumer credit is giving meaningful information concerning the cost of such credit

Created by: Mmart1018

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