Question

1. a customer service representative created a false member account and would submit dr. visit claims to the healthcare insurance. a. false – claim act b. anti - kickback statute c. physician - self referral law d. civil monetary penalties law

Explanation:

The scenario involves submitting fraudulent, false claims to healthcare insurance, which directly aligns with the False-Claim Act, which targets the submission of false or fraudulent claims to the government/insurance programs for payment. The other laws focus on different healthcare fraud-related areas: Anti-Kickback deals with improper referrals for payment, Physician-Self Referral (Stark Law) covers self-referral for designated health services, and Civil Monetary Penalties Law imposes penalties for various violations but is not the primary law for false claim submission.

Answer:

A. False – Claim Act