AHIP - Discrimination, Fraud, Waste, & Abuse - 2026
Study online at https://quizlet.com/_hh0s77
1. Under ACA Section 1557, a health plan premium sold through a state ex-
change may, based on an individual's age and: charge higher premiums.
2. As a result of violations of ACA Section 1557 nondiscrimination rules,: a health
plan may revoke an agent or broker's appointment with the health plan.
3. ACA Section 1557 rules for disability concern: policies and procedures, physical access, and
communication.
4. Which Medicare programs are covered by ACA Section 1557 under the Biden
Administration's Final Rule (2024)?: Parts A, C, and D, and Part B.
5. Which of the following statements best describes Section 1557 of the Afford-
able Care Act (ACA)?: Section 1557 incorporates earlier civil rights protections in regard to race, color, national
origin, disability, age and sex.
6. Section 1557 of the Affordable Care Act applies to: all health programs and activities
administered by or receiving federal financial assistance from HHS.
7. Which of the following would be considered permissible under Section 1557?-
: Broker Mary Jones has recruited a diverse workforce. She encourages her agents to prospect through communi-
ty-based marketing and within their community of influence.
8. Which of these actions is most likely to be permitted in dealing with a person
with limited English proficiency?: Allowing a child to interpret in an emergency.
9. Which of the following statements best describes the scope of operations
subject to Section 1557 under the Final Rule (2024) of the Biden Administra-
tion?: Entities principally engaged in health care, which includes health insurers, must comply with Section 1557 for
all programs they offer.
10. For a health plan, what are the possible consequences of violations of ACA
Section 1557?: Loss of federal business and compensatory damages.
11. Auxiliary aids and services must be provided to individuals with disabilities,
such as those suffering from vision or hearing impairments, free of charge, and
in a timely manner. Auxiliary aids and services include which of the following:
I. large print materials
II. qualified sign language interpreters
III. braille materials and displays
IV. screen reader software: I, II, III, and IV
1/5
, AHIP - Discrimination, Fraud, Waste, & Abuse - 2026
Study online at https://quizlet.com/_hh0s77
12. Under ACA Section 1557, a health plan: cannot deny coverage to LEP individuals and is required
to provide language assistance to them, free of charge.
13. Under Section 1557, the 2020 Final Rule issued during the Trump Adminis-
tration sex was initially defined____________: as biologic sex only, meaning whether a person was
determined to be male or female at birth.
14. Which entity enforces Section 1557 for programs that receive funding from
and are administered by HHS?: The Office of Civil Rights (OCR) of HHS.
15. You are performing a regular inventory of the controlled substances in
the pharmacy. You discover a minor inventory discrepancy. What should you
do?: Follow your pharmacy's procedures.
16. A person drops off a prescription for a beneficiary who is a "regular" cus-
tomer. The prescription is for a controlled substance with a quantity of 160.
This beneficiary normally receives a quantity of 60, not 160. You review the
prescription and have concerns about possible forgery. What is your next
step?: Call the prescriber to verify the quantity
17. Which of the following requires intent to obtain payment and the knowledge
the actions are wrong?: Fraud
18. You are in charge of paying claims submitted by providers. You notice a cer-
tain diagnostic provider ("Doe Diagnostics") requested a substantial payment
for a large patient group. Many of these claims are for a certain procedure.
You review the same type of procedure for other diagnostic providers and
realize Doe Diagnostics' claims far exceed any other provider you reviewed.
What should you do?: Consult with your immediate supervisor for next steps or contact the compliance
department (via compliance hotline, Special Investigations Unit [SIU], or other mechanism)
19. Your job is to submit a risk diagnosis to the Centers for Medicare & Medicaid
Services (CMS) for the purpose of payment. As part of this job, you use a process
to verify the data is accurate. Your immediate supervisor tells you to ignore
the Sponsor's process and to adjust or add risk diagnosis codes for certain
individuals. What should you do?: Report the incident to the compliance department (via compliance
hotline or other mechanism)
20. Which of the following is NOT potentially a penalty for violation of a law or
regulation prohibiting fraud, waste, and abuse (FWA)?: Deportation
2/5
Study online at https://quizlet.com/_hh0s77
1. Under ACA Section 1557, a health plan premium sold through a state ex-
change may, based on an individual's age and: charge higher premiums.
2. As a result of violations of ACA Section 1557 nondiscrimination rules,: a health
plan may revoke an agent or broker's appointment with the health plan.
3. ACA Section 1557 rules for disability concern: policies and procedures, physical access, and
communication.
4. Which Medicare programs are covered by ACA Section 1557 under the Biden
Administration's Final Rule (2024)?: Parts A, C, and D, and Part B.
5. Which of the following statements best describes Section 1557 of the Afford-
able Care Act (ACA)?: Section 1557 incorporates earlier civil rights protections in regard to race, color, national
origin, disability, age and sex.
6. Section 1557 of the Affordable Care Act applies to: all health programs and activities
administered by or receiving federal financial assistance from HHS.
7. Which of the following would be considered permissible under Section 1557?-
: Broker Mary Jones has recruited a diverse workforce. She encourages her agents to prospect through communi-
ty-based marketing and within their community of influence.
8. Which of these actions is most likely to be permitted in dealing with a person
with limited English proficiency?: Allowing a child to interpret in an emergency.
9. Which of the following statements best describes the scope of operations
subject to Section 1557 under the Final Rule (2024) of the Biden Administra-
tion?: Entities principally engaged in health care, which includes health insurers, must comply with Section 1557 for
all programs they offer.
10. For a health plan, what are the possible consequences of violations of ACA
Section 1557?: Loss of federal business and compensatory damages.
11. Auxiliary aids and services must be provided to individuals with disabilities,
such as those suffering from vision or hearing impairments, free of charge, and
in a timely manner. Auxiliary aids and services include which of the following:
I. large print materials
II. qualified sign language interpreters
III. braille materials and displays
IV. screen reader software: I, II, III, and IV
1/5
, AHIP - Discrimination, Fraud, Waste, & Abuse - 2026
Study online at https://quizlet.com/_hh0s77
12. Under ACA Section 1557, a health plan: cannot deny coverage to LEP individuals and is required
to provide language assistance to them, free of charge.
13. Under Section 1557, the 2020 Final Rule issued during the Trump Adminis-
tration sex was initially defined____________: as biologic sex only, meaning whether a person was
determined to be male or female at birth.
14. Which entity enforces Section 1557 for programs that receive funding from
and are administered by HHS?: The Office of Civil Rights (OCR) of HHS.
15. You are performing a regular inventory of the controlled substances in
the pharmacy. You discover a minor inventory discrepancy. What should you
do?: Follow your pharmacy's procedures.
16. A person drops off a prescription for a beneficiary who is a "regular" cus-
tomer. The prescription is for a controlled substance with a quantity of 160.
This beneficiary normally receives a quantity of 60, not 160. You review the
prescription and have concerns about possible forgery. What is your next
step?: Call the prescriber to verify the quantity
17. Which of the following requires intent to obtain payment and the knowledge
the actions are wrong?: Fraud
18. You are in charge of paying claims submitted by providers. You notice a cer-
tain diagnostic provider ("Doe Diagnostics") requested a substantial payment
for a large patient group. Many of these claims are for a certain procedure.
You review the same type of procedure for other diagnostic providers and
realize Doe Diagnostics' claims far exceed any other provider you reviewed.
What should you do?: Consult with your immediate supervisor for next steps or contact the compliance
department (via compliance hotline, Special Investigations Unit [SIU], or other mechanism)
19. Your job is to submit a risk diagnosis to the Centers for Medicare & Medicaid
Services (CMS) for the purpose of payment. As part of this job, you use a process
to verify the data is accurate. Your immediate supervisor tells you to ignore
the Sponsor's process and to adjust or add risk diagnosis codes for certain
individuals. What should you do?: Report the incident to the compliance department (via compliance
hotline or other mechanism)
20. Which of the following is NOT potentially a penalty for violation of a law or
regulation prohibiting fraud, waste, and abuse (FWA)?: Deportation
2/5
