When a Patient Has No Symptoms of a Disease and the Provider

question 48

Multiple Choice

When a patient has no symptoms of a disease and the provider performs the tests for that disease at the patient's request, the provider has committed which of these fraudulent coding and billing practices?

• A) Reporting services that were not performed
• B) Reporting services at a higher level than was carried out
• C) Performing procedures not related to the patient's condition
• D) Billing separately for services that are bundled in a single procedure code
• E) Reporting the same service twice

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Definitions:

Per Se Violation

An action that is inherently illegal and does not require further proof of harm or anticompetitive effects to be considered a breach of law.

Sherman Act

A foundational U.S. antitrust law enacted in 1890 to prevent monopolies and promote competition among businesses.

Natural Gas

A fossil fuel composed mainly of methane, used as an energy source for heating, cooking, and electricity generation.

Foster Competition

means to encourage or promote a marketplace environment where businesses vie against one another, aiming to improve quality, innovation, and consumer choice.