AHFI Exam Questions & Answers | 100%
Verified solutions (2026)
UPDATE|2026!! STUDY GUIDE EXAM
Anti-Kickback Statute (42 US SS 1320a-7b (b) prohibitions - ANSWER-Prohibits
offering, paying, soliciting or reviving anything of value to induce or reward
referrals or generate Federal health care program business
Anti-Kickback Statute (42 US SS 1320a-7b (b) referrals - ANSWER-Referrals from
anyone
Anti-Kickback Statute (42 US SS 1320a-7b (b) - ANSWER-Any items or services
Anti-Kickback Statute (42 US SS 1320a-7b (b) (Intent) - ANSWER-Intent MUST be
proven (knowing and willful)
Anti-Kickback Statute (42 US SS 1320a-7b (b) Criminal penalties - ANSWER-Fines
up to $25,000/violation
Up to a 5-yr prison term/violation
Anti-Kickback Statute (42 US SS 1320a-7b (b) (Civil/administrative) - ANSWER-
False Claims act liability
,Civil monetary penalties and program exclusions
Potential $50,000 CMP/violation
Civil assessment of up to 3x amount of kickback
Anti-Kickback Statute (42 US SS 1320a-7b (b) Exceptions - ANSWER-Voluntary safe
harbors
Anti-Kickback Statute (42 US SS 1320a-7b (b) - what it applies to... - ANSWER-All
Federal Health Care Programs
The Stark Law (42 US SS 139nn) Prohibition - ANSWER-Prohibits a physician from
referring Medicare patients for designated health services to an entity with which
the physician (or immediate family member) has a financial relationship, unless an
exception applies)
Prohibits the designated health services entity from submitting claims to Medicare
for those services resulting from a prohibited referral
The Stark Law (42 US SS 139nn) Referrals - ANSWER-Referrals from a physician
The Stark Law (42 US SS 139nn) (Items/Services) - ANSWER-Designated health
services
,The Stark Law (42 US SS 139nn) (Intent) - ANSWER-No intent standard for
overpayment (strict liability)
Intent required for civil monetary penalties for knowing violations
The Stark Law (42 US SS 139nn) (Civil Penalties) only - ANSWER-
Overpayment/refund obligation
False Claims Act liability
Civil monetary penalties and program exclusion for knowing violations
Potential $15,000 CMP for each service
Civil assessment of up to 3x the amount claimed.
The Stark Law (42 US SS 139nn) (Exceptions) - ANSWER-Mandatory exceptions
The Stark Law (42 US SS 139nn) applies to - ANSWER-Medicare and Medicaid
(No commercial or tricare)
MACs: - ANSWER-Medicare Administrative Contractors
, They analyze claims to determine provider compliance with Medicare coverage,
coding, and billing rules and take appropriate corrective action when providers are
found to be non-compliant.
The goal of Mac administrative actions - ANSWER-To correct the behavior in need
of change and prevent future inappropriate billing
The priority of MACs - ANSWER-To minimize potential future losses to the
Medicare Trust Fund through targeted claims review while using resource
efficiently and treating providers and beneficiaries fairly.
For repeated infractions, MACs have - ANSWER-The discretion to initiate
progressively more severe administrative action, commensurate with the
seriousness of the identified problem. (See Program Integrity Manual (PIM)
chapter 3, SS3. 7.1)
Medicare Fee For Service Recovery Audit Program - ANSWER-Legislative
mandated program (Tax Relief and Health Care act of 2006)
Utilizes Recovery Auditors to identify improper payments paid by Medicare to fee-
for-service providers.
Recovery Auditors identify improper payments
Verified solutions (2026)
UPDATE|2026!! STUDY GUIDE EXAM
Anti-Kickback Statute (42 US SS 1320a-7b (b) prohibitions - ANSWER-Prohibits
offering, paying, soliciting or reviving anything of value to induce or reward
referrals or generate Federal health care program business
Anti-Kickback Statute (42 US SS 1320a-7b (b) referrals - ANSWER-Referrals from
anyone
Anti-Kickback Statute (42 US SS 1320a-7b (b) - ANSWER-Any items or services
Anti-Kickback Statute (42 US SS 1320a-7b (b) (Intent) - ANSWER-Intent MUST be
proven (knowing and willful)
Anti-Kickback Statute (42 US SS 1320a-7b (b) Criminal penalties - ANSWER-Fines
up to $25,000/violation
Up to a 5-yr prison term/violation
Anti-Kickback Statute (42 US SS 1320a-7b (b) (Civil/administrative) - ANSWER-
False Claims act liability
,Civil monetary penalties and program exclusions
Potential $50,000 CMP/violation
Civil assessment of up to 3x amount of kickback
Anti-Kickback Statute (42 US SS 1320a-7b (b) Exceptions - ANSWER-Voluntary safe
harbors
Anti-Kickback Statute (42 US SS 1320a-7b (b) - what it applies to... - ANSWER-All
Federal Health Care Programs
The Stark Law (42 US SS 139nn) Prohibition - ANSWER-Prohibits a physician from
referring Medicare patients for designated health services to an entity with which
the physician (or immediate family member) has a financial relationship, unless an
exception applies)
Prohibits the designated health services entity from submitting claims to Medicare
for those services resulting from a prohibited referral
The Stark Law (42 US SS 139nn) Referrals - ANSWER-Referrals from a physician
The Stark Law (42 US SS 139nn) (Items/Services) - ANSWER-Designated health
services
,The Stark Law (42 US SS 139nn) (Intent) - ANSWER-No intent standard for
overpayment (strict liability)
Intent required for civil monetary penalties for knowing violations
The Stark Law (42 US SS 139nn) (Civil Penalties) only - ANSWER-
Overpayment/refund obligation
False Claims Act liability
Civil monetary penalties and program exclusion for knowing violations
Potential $15,000 CMP for each service
Civil assessment of up to 3x the amount claimed.
The Stark Law (42 US SS 139nn) (Exceptions) - ANSWER-Mandatory exceptions
The Stark Law (42 US SS 139nn) applies to - ANSWER-Medicare and Medicaid
(No commercial or tricare)
MACs: - ANSWER-Medicare Administrative Contractors
, They analyze claims to determine provider compliance with Medicare coverage,
coding, and billing rules and take appropriate corrective action when providers are
found to be non-compliant.
The goal of Mac administrative actions - ANSWER-To correct the behavior in need
of change and prevent future inappropriate billing
The priority of MACs - ANSWER-To minimize potential future losses to the
Medicare Trust Fund through targeted claims review while using resource
efficiently and treating providers and beneficiaries fairly.
For repeated infractions, MACs have - ANSWER-The discretion to initiate
progressively more severe administrative action, commensurate with the
seriousness of the identified problem. (See Program Integrity Manual (PIM)
chapter 3, SS3. 7.1)
Medicare Fee For Service Recovery Audit Program - ANSWER-Legislative
mandated program (Tax Relief and Health Care act of 2006)
Utilizes Recovery Auditors to identify improper payments paid by Medicare to fee-
for-service providers.
Recovery Auditors identify improper payments
