AHIP FWA EXAM QANDA 2026 STUDY
SHEET QUESTIONS AND SOLUTIONS
GRADED A+
●● 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?
Answer: Report the incident to the compliance department (via
compliance hotline or other mechanism)
●● Which of the following is NOT potentially a penalty for violation of
a law or regulation prohibiting fraud, waste, and abuse (FWA)?
Answer: Deportation
●● You are performing a regular inventory of the controlled substances
in the pharmacy. You discover a minor inventory discrepancy. What
should you do?
Answer: Follow your pharmacy's procedures.
●● A person drops off a prescription for a beneficiary who is a "regular"
customer. 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?
Answer: Call the prescriber to verify the quantity
●● You are in charge of paying claims submitted by providers. You
notice a certain 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?
Answer: Consult with your immediate supervisor for next steps or
contact the compliance department (via compliance hotline, Special
Investigations Unit [SIU], or other mechanism)
●● Bribes or kickbacks of any kind for services that are paid under a
Federal health care program (which includes Medicare) constitute fraud
by the person making as well as the person receiving them.
Answer: True
●● Some of the laws governing Medicare Part C and D fraud, waste, and
abuse (FWA) include the Health Insurance Portability and
Accountability Act (HIPAA), the Civil False Claims Act, the Anti-
Kickback Statute, and the Criminal Health Care Fraud Statute.
Answer: True
SHEET QUESTIONS AND SOLUTIONS
GRADED A+
●● 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?
Answer: Report the incident to the compliance department (via
compliance hotline or other mechanism)
●● Which of the following is NOT potentially a penalty for violation of
a law or regulation prohibiting fraud, waste, and abuse (FWA)?
Answer: Deportation
●● You are performing a regular inventory of the controlled substances
in the pharmacy. You discover a minor inventory discrepancy. What
should you do?
Answer: Follow your pharmacy's procedures.
●● A person drops off a prescription for a beneficiary who is a "regular"
customer. 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?
Answer: Call the prescriber to verify the quantity
●● You are in charge of paying claims submitted by providers. You
notice a certain 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?
Answer: Consult with your immediate supervisor for next steps or
contact the compliance department (via compliance hotline, Special
Investigations Unit [SIU], or other mechanism)
●● Bribes or kickbacks of any kind for services that are paid under a
Federal health care program (which includes Medicare) constitute fraud
by the person making as well as the person receiving them.
Answer: True
●● Some of the laws governing Medicare Part C and D fraud, waste, and
abuse (FWA) include the Health Insurance Portability and
Accountability Act (HIPAA), the Civil False Claims Act, the Anti-
Kickback Statute, and the Criminal Health Care Fraud Statute.
Answer: True
