AHIP FWA ACTUAL TEST PAPER 2026
COMPLETE QUESTIONS AND ANSWERS
BUNDLED
●● Subcontractor means.
Answer: **An individual or entity that provides services on behalf of a
Medicare plan sponsor. This includes individuals and organizations with
DIRECT relationship with the plan sponsor or individuals or
organizations with INDIRECT relationship, such as an agent who has a
contract with an agency or filed marketing organization that contract
with a Medicare plan.
●● FWA Training: A compliance program component.
Answer: **ALL Medicare plans are required to have robust programs to
assure compliance by plan employees an subcontractors with all
applicable laws, regulations and program guidance.
**One required component of a compliance program is a FWA program
to identify and address issues of compliance with FWA.
**It is important to remember that ALL Medicare plan sponsor
employees and subcontractors are responsible for complying with all
relevant Medicare requirements, even if lack of compliance may not be
viewed as FWA,
●● FWA: Why participate in the training.
,Answer: **Fraud, waste and abuse impacts everyone who receives or
relies on healthcare in the US.
**The purpose of this training is to help you detect, correct and prevent
FWA and your help is needed. You are part of the solution!
**As a subcontractor to or an employee of a Medicare plan, you are
required to participate in FWA training.
●● FWA: Combating: A federal priority.
Answer: **Important priority for the Federal Government.
**CMS, the Federal agency responsible for administering these
programs, takes its role in leading anti-fraud efforts very seriously and
has issued strict requirements for those involved in providing MA and
Medicare Part D coverage.
**The office of Inspector General, a sister agency to CMS within the US
Department of Health and Human Services , is also actively involved in
anti-fraud efforts.
●● Steps by Medicare plans to Combat FWA.
Answer: --The establishment and operation of special investigation units
(SIU) or other existing departments that perform an internal
investigation function
--The analysis of claims data
--Collaboration with law enforcement agencies
--Adherence to rules set forth by CMS regarding efforts to identify and
prevent fraud, waste and abuse.
, ●● CMS Anti-FWA requirements for Medicare plans.
Answer: --Actively seek to prevent fraud, waste and abuse
--Detect and investigate suspected FWA
--Implement corrective action when instances of FWA are uncovered
--Have a system in place 24 hrs per day for employees and
subcontractors to voluntarily, and confidentially report suspected FWA
or misconduct related to the MA and Part D programs
●● CMS FWA training requirements for a Sponsor's Employees.
Answer: **CMS requires Medicare plan sponsors to provide training in
FWA to their employees involved in Medicare plan work.
**This training must occur within 90 days of hire and annually
thereafter.
●● CMS FWA training requirements: Agents, Brokers and other
Subcontractors.
Answer: **The FWA training must be received not only by Medicare
plan sponsor employees but also by subcontractors and their employees
who are under contract to provide health or administrative services. The
EXCEPTIONS are limited to:
***accredited suppliers of DME, prosthetics, orthotics, and supplies
(DMEPOS)
***Healthcare providers who are enrolled in Medicare Part A/B
COMPLETE QUESTIONS AND ANSWERS
BUNDLED
●● Subcontractor means.
Answer: **An individual or entity that provides services on behalf of a
Medicare plan sponsor. This includes individuals and organizations with
DIRECT relationship with the plan sponsor or individuals or
organizations with INDIRECT relationship, such as an agent who has a
contract with an agency or filed marketing organization that contract
with a Medicare plan.
●● FWA Training: A compliance program component.
Answer: **ALL Medicare plans are required to have robust programs to
assure compliance by plan employees an subcontractors with all
applicable laws, regulations and program guidance.
**One required component of a compliance program is a FWA program
to identify and address issues of compliance with FWA.
**It is important to remember that ALL Medicare plan sponsor
employees and subcontractors are responsible for complying with all
relevant Medicare requirements, even if lack of compliance may not be
viewed as FWA,
●● FWA: Why participate in the training.
,Answer: **Fraud, waste and abuse impacts everyone who receives or
relies on healthcare in the US.
**The purpose of this training is to help you detect, correct and prevent
FWA and your help is needed. You are part of the solution!
**As a subcontractor to or an employee of a Medicare plan, you are
required to participate in FWA training.
●● FWA: Combating: A federal priority.
Answer: **Important priority for the Federal Government.
**CMS, the Federal agency responsible for administering these
programs, takes its role in leading anti-fraud efforts very seriously and
has issued strict requirements for those involved in providing MA and
Medicare Part D coverage.
**The office of Inspector General, a sister agency to CMS within the US
Department of Health and Human Services , is also actively involved in
anti-fraud efforts.
●● Steps by Medicare plans to Combat FWA.
Answer: --The establishment and operation of special investigation units
(SIU) or other existing departments that perform an internal
investigation function
--The analysis of claims data
--Collaboration with law enforcement agencies
--Adherence to rules set forth by CMS regarding efforts to identify and
prevent fraud, waste and abuse.
, ●● CMS Anti-FWA requirements for Medicare plans.
Answer: --Actively seek to prevent fraud, waste and abuse
--Detect and investigate suspected FWA
--Implement corrective action when instances of FWA are uncovered
--Have a system in place 24 hrs per day for employees and
subcontractors to voluntarily, and confidentially report suspected FWA
or misconduct related to the MA and Part D programs
●● CMS FWA training requirements for a Sponsor's Employees.
Answer: **CMS requires Medicare plan sponsors to provide training in
FWA to their employees involved in Medicare plan work.
**This training must occur within 90 days of hire and annually
thereafter.
●● CMS FWA training requirements: Agents, Brokers and other
Subcontractors.
Answer: **The FWA training must be received not only by Medicare
plan sponsor employees but also by subcontractors and their employees
who are under contract to provide health or administrative services. The
EXCEPTIONS are limited to:
***accredited suppliers of DME, prosthetics, orthotics, and supplies
(DMEPOS)
***Healthcare providers who are enrolled in Medicare Part A/B
