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- ACFE.CFE-Financial-Transactions-and-Fraud-Schemes.v2025-10-12.q96
- Question 45
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Question 45/96
Mario performs surgery on a patient to replace a bone. The surgery should be billed using one code, but Mario bills the surgery using three codes (one for the entire surgery, one for the removal of the bone, and another for the insertion of the artificial bone), which increases the cost. Which of the following BEST describes Mario's scheme?
Correct Answer: D
Detailed Explanation:
* Rationale for Correct Answer:This is unbundling, where services that should be billed under a single comprehensive code are split into multiple components to inflate reimbursement.
* Analysis of Incorrect Options:
* A. Fictitious services - Charging for services not performed.
* B. False diagnosis - Fabricating diagnoses to justify billing.
* C. Upcoding - Billing for more expensive services than provided.
* Key Concept: Health care billing fraud - unbundling.
Reference: ACFE Fraud Examiners Manual (2020), Fraudulent Disbursements: Health Care Billing Schemes
.
* Rationale for Correct Answer:This is unbundling, where services that should be billed under a single comprehensive code are split into multiple components to inflate reimbursement.
* Analysis of Incorrect Options:
* A. Fictitious services - Charging for services not performed.
* B. False diagnosis - Fabricating diagnoses to justify billing.
* C. Upcoding - Billing for more expensive services than provided.
* Key Concept: Health care billing fraud - unbundling.
Reference: ACFE Fraud Examiners Manual (2020), Fraudulent Disbursements: Health Care Billing Schemes
.
- Question List (96q)
- Question 1: Which of the following is a method that might be used to fra...
- Question 2: Which of the following can constitute a bribe, even if the i...
- Question 3: Which of the following statements is TRUE regarding income s...
- Question 4: The excess credits (or debits) on the income statement are u...
- Question 5: Which of the following is an example of a cash larceny schem...
- Question 6: Which of the following offender types are people who take th...
- Question 7: To detect fraud committed by a health care provider, a fraud...
- Question 8: __________ means that traditional bribery statutes proscribe...
- Question 9: A special scheme in which employees know their employer is s...
- Question 10: Which of the following is NOT the reason to bribe employees ...
- Question 11: The most basic skimming scheme occurs when:...
- Question 12: __________ may be defined as the offering, giving, receiving...
- Question 13: Which of the following ratios can be used to determine the e...
- Question 14: What can make it easy for an employee to skim sales or recei...
- Question 15: In the fraud scale, pressure, opportunity, and integrity var...
- Question 16: Placing any restriction in the solicitation documents that t...
- Question 17: Which of the following is FALSE concerning methods that corp...
- Question 18: Which of the following is TRUE regarding accrual-basis accou...
- Question 19: Organizations that had external audits actually had higher m...
- Question 20: Undisclosed payments made by vendors to employees of purchas...
- Question 21: The principal way to detect omitted credits from books of ac...
- Question 22: Black, an accounts receivable clerk, stole Customer A's mont...
- Question 23: Which of the following is a recommended method for safeguard...
- Question 24: George, a 71-year-old man, receives a fraudulent message on ...
- Question 25: Larceny by fraud or deception means that:...
- Question 26: Which of the following is NOT a measure that is commonly tak...
- Question 27: __________ inventory and other assets is a relatively common...
- Question 28: Entering a sales total lower than the amount actually paid b...
- Question 29: Delivery has not occurred or services have not been rendered...
- Question 30: Which of the following is NOT a justifiable reason to depart...
- Question 31: Every bribe is a two-sided transaction, in which where a ven...
- Question 32: A typical issue involving materiality and fraud would be:...
- Question 33: Which of the following are used in a short-term skimming sch...
- Question 34: Which of the following is the criterion for bid solicitation...
- Question 35: Which of the following is NOT a phase of the bidding process...
- Question 36: Which of the following is a common way that dishonest contra...
- Question 37: ________, one of the synonyms for fraud, implies deceiving s...
- Question 38: Which of the following is NOT one of the information securit...
- Question 39: According to Marshall, ______ are probable future economic b...
- Question 40: ____________ is a process by which a bookkeeper records all ...
- Question 41: How many accounts are affected in fraudulent accounting entr...
- Question 42: The difference between assets and liabilities is called:...
- Question 43: Which of the following controls BEST describes the safeguard...
- Question 44: Which of the following is NOT a medium that commonly causes ...
- Question 45: Mario performs surgery on a patient to replace a bone. The s...
- Question 46: Larceny is the scheme in which an employee simply takes inve...
- Question 47: The most common method of detection in corruption cases is:...
- Question 48: Which of the following methods is NOT used to detect conflic...
- Question 49: Baker, an employee of ABC Corporation, was the only employee...
- Question 50: Which of the following methods would NOT be helpful in detec...
- Question 51: In ____________ scheme, a supplier pays an employee of the p...
- Question 52: Which of the following is MOST ACCURATE concerning common me...
- Question 53: According to the recommended methodology for responding to c...
- Question 54: Which of the following are the classifications for Corruptio...
- Question 55: To prevent expense reimbursement fraud, it is recommended th...
- Question 56: Joe's automobile insurance policy expired in June. In August...
- Question 57: The _______________ cost method of pricing would carry an as...
- Question 58: Which of the following statements regarding financial statem...
- Question 59: By what accountant means that the financial figures presente...
- Question 60: Which of the following actions would balance the accounting ...
- Question 61: Hannah is a manager at a financial institution. To safeguard...
- Question 62: Which of the following is a method that a fraudster might us...
- Question 63: A scheme is classified as a Conflict of Interest:...
- Question 64: A tangible asset is one which is:...
- Question 65: Another way to eliminate competition in the solicitation pha...
- Question 66: ________ decrease assets and expenses and/or increase liabil...
- Question 67: One of the simplest ways to justify unacceptable conduct and...
- Question 68: People commit financial statement fraud to:...
- Question 69: Which of the following is one of the sections on the stateme...
- Question 70: Reconciling the sales records to the cash receipts is an eff...
- Question 71: Financial statement fraud is committed by:...
- Question 72: Fraudsters use the accounting system as a tool to generate t...
- Question 73: A client contacts Emma, a Certified Fraud Examiner (CFE), an...
- Question 74: The scheme in which the same vendor is receiving favorable t...
- Question 75: According to accounting principles, ________ and ________ sh...
- Question 76: An analytical review reveals that XYZ Company's cost of good...
- Question 77: Which of the following statements is MOST ACCURATE regarding...
- Question 78: In what type of fraud scheme does an employee steal cash aft...
- Question 79: Which of the following is an example of a corruption scheme?...
- Question 80: Which of the following is NOT an example of bribery preventi...
- Question 81: Not having any accounts receivable that are overdue is a com...
- Question 82: Which of the following scenarios describes a card skimming o...
- Question 83: In Cressey's fraud triangle, its three legs are Opportunity,...
- Question 84: A journal in which all sales made on credit or cash are list...
- Question 85: Any expenses that are incurred but not paid by the end of th...
- Question 86: Which of the following factors is NOT included in most finan...
- Question 87: Once the expense account is closed, it becomes a historical ...
- Question 88: In which phase of the competitive bidding process do fraudst...
- Question 89: In which approach do fraudsters produce whatever financial s...
- Question 90: Which of the following is a method of identity theft prevent...
- Question 91: Which of the following is NOT a common way that a procuring ...
- Question 92: _____________ involves purposeful misreporting of financial ...
- Question 93: Which of the following is NOT the reason why senior manageme...
- Question 94: According to the Fraud Tree, cash has three following scheme...
- Question 95: Which of the following is a condition that facilitates insid...
- Question 96: Several people who work in real estate collude to obtain a l...
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