AHIP FWA Module Exam (PDF) | Updated AHIP
Exam Questions | Medicare Compliance
1. Which of the following best defines "fraud" under
Medicare program?
A) An intentional deception or misrepresentation made by
a person with knowledge that the deception could result
in an unauthorized benefit.
B) An overpayment resulting from a clerical error in
billing.
C) A pattern of unnecessary services provided without
malicious intent.
D) Any act that increases Medicare costs regardless of
intent.
Answer: A
Rationale: Fraud requires intent (knowing or reckless
disregard) to deceive. Waste and abuse may lack intent,
but fraud is knowing and willful.
1
,2. Which is an example of "waste" in Medicare?
A) Billing for a service not rendered.
B) Using a higher-cost diagnostic test when a lower-cost,
equally effective test exists.
C) Knowingly billing for non-covered services as covered.
D) Providing kickbacks to a physician for referrals.
Answer: B
Rationale: Waste involves overuse of resources without
intent to harm or deceive, unlike fraud (knowing
deception) or abuse (payment for non-covered but not
necessarily deceptive).
3. The term "abuse" in Medicare compliance most closely
refers to:
A) Practices that are inconsistent with sound medical
business practice and result in unnecessary costs.
B) Criminal acts involving misrepresentation.
C) Accidental billing errors.
D) Patient neglect in a nursing home.
2
,Answer: A
Rationale: Abuse is broader than fraud but less severe; it
includes actions that are inconsistent with accepted
standards and cause unnecessary costs, but without clear
fraudulent intent.
4. What is the primary federal law that prohibits
knowingly and willfully soliciting or receiving any
remuneration for referrals for services payable by
federal healthcare programs?
A) False Claims Act (FCA)
B) Anti-Kickback Statute (AKS)
C) Stark Law
D) Health Insurance Portability and Accountability Act
(HIPAA)
Answer: B
Rationale: The Anti-Kickback Statute specifically targets
remuneration for referrals. The Stark Law addresses
physician self-referral for designated health services.
3
, 5. Under the Civil Monetary Penalties Law (CMPL), CMS
can impose penalties for:
A) Only fraud convictions.
B) Presenting a claim for an item or service that was not
provided as claimed.
C) Unintentional billing errors under $500.
D) Patient complaints about quality.
Answer: B
Rationale: CMPL allows CMS to impose penalties for
many abusive practices, including presenting false claims,
upcoding, and kickbacks, even without criminal intent.
6. Which law is often called the "Physician Self-Referral
Law"?
A) Anti-Kickback Statute
B) Stark Law
C) False Claims Act
D) Social Security Act Title XI
4
Exam Questions | Medicare Compliance
1. Which of the following best defines "fraud" under
Medicare program?
A) An intentional deception or misrepresentation made by
a person with knowledge that the deception could result
in an unauthorized benefit.
B) An overpayment resulting from a clerical error in
billing.
C) A pattern of unnecessary services provided without
malicious intent.
D) Any act that increases Medicare costs regardless of
intent.
Answer: A
Rationale: Fraud requires intent (knowing or reckless
disregard) to deceive. Waste and abuse may lack intent,
but fraud is knowing and willful.
1
,2. Which is an example of "waste" in Medicare?
A) Billing for a service not rendered.
B) Using a higher-cost diagnostic test when a lower-cost,
equally effective test exists.
C) Knowingly billing for non-covered services as covered.
D) Providing kickbacks to a physician for referrals.
Answer: B
Rationale: Waste involves overuse of resources without
intent to harm or deceive, unlike fraud (knowing
deception) or abuse (payment for non-covered but not
necessarily deceptive).
3. The term "abuse" in Medicare compliance most closely
refers to:
A) Practices that are inconsistent with sound medical
business practice and result in unnecessary costs.
B) Criminal acts involving misrepresentation.
C) Accidental billing errors.
D) Patient neglect in a nursing home.
2
,Answer: A
Rationale: Abuse is broader than fraud but less severe; it
includes actions that are inconsistent with accepted
standards and cause unnecessary costs, but without clear
fraudulent intent.
4. What is the primary federal law that prohibits
knowingly and willfully soliciting or receiving any
remuneration for referrals for services payable by
federal healthcare programs?
A) False Claims Act (FCA)
B) Anti-Kickback Statute (AKS)
C) Stark Law
D) Health Insurance Portability and Accountability Act
(HIPAA)
Answer: B
Rationale: The Anti-Kickback Statute specifically targets
remuneration for referrals. The Stark Law addresses
physician self-referral for designated health services.
3
, 5. Under the Civil Monetary Penalties Law (CMPL), CMS
can impose penalties for:
A) Only fraud convictions.
B) Presenting a claim for an item or service that was not
provided as claimed.
C) Unintentional billing errors under $500.
D) Patient complaints about quality.
Answer: B
Rationale: CMPL allows CMS to impose penalties for
many abusive practices, including presenting false claims,
upcoding, and kickbacks, even without criminal intent.
6. Which law is often called the "Physician Self-Referral
Law"?
A) Anti-Kickback Statute
B) Stark Law
C) False Claims Act
D) Social Security Act Title XI
4
