AHIP - Discrimination, Fraud, Waste, & Abuse – 2026 Questions with Answers
Graded A+
Under ACA Section 1557, a health plan premium sold
through a state exchange may, based on an individual's charge higher premiums.
age and
As a result of violations of ACA Section 1557 nondiscrimi- a health plan may revoke an agent or broker's appoint-
nation rules, ment with the health plan.
policies and procedures, physical access, and communi-
ACA Section 1557 rules for disability concern
cation.
Which Medicare programs are covered by ACA Section
Parts A, C, and D, and Part B.
1557 under the Biden Administration's Final Rule (2024)?
Section 1557 incorporates earlier civil rights protections
Which of the following statements best describes Section
in regard to race, color, national origin, disability, age and
1557 of the Attordable Care Act (ACA)?
sex.
all health programs and activities administered by or re-
Section 1557 of the Attordable Care Act applies to
ceiving federal financial assistance from HHS.
Broker Mary Jones has recruited a diverse workforce. She
Which of the following would be considered permissible encourages her agents to prospect through communi-
under Section 1557? ty-based marketing and within their community of influ-
ence.
Which of these actions is most likely to be permitted in
Allowing a child to interpret in an emergency.
dealing with a person with limited English proficiency?
Which of the following statements best describes the Entities principally engaged in health care, which includes
scope of operations subject to Section 1557 under the health insurers, must comply with Section 1557 for all
Final Rule (2024) of the Biden Administration? programs they otter.
For a health plan, what are the possible consequences of
Loss of federal business and compensatory damages.
violations of ACA Section 1557?
Auxiliary aids and services must be provided to individ-
uals with disabilities, such as those suttering from vision
or hearing impairments, free of charge, and in a timely
1/6
, AHIP - Discrimination, Fraud, Waste, & Abuse – 2026 Questions with Answers
Graded A+
manner. Auxiliary aids and services include which of the
following:
I. large print materials
I, II, III, and IV
II. qualified sign language interpreters
III. braille materials and displays
IV. screen reader software
cannot deny coverage to LEP individuals and is required
Under ACA Section 1557, a health plan
to provide language assistance to them, free of charge.
Under Section 1557, the 2020 Final Rule issued dur-
as biologic sex only, meaning whether a person was de-
ing the Trump Administration sex was initially de-
termined to be male or female at birth.
fined
Which entity enforces Section 1557 for programs that
The Oflce of Civil Rights (OCR) of HHS.
receive funding from and are administered by HHS?
You are performing a regular inventory of the controlled
substances in the pharmacy. You discover a minor inven- Follow your pharmacy's procedures.
tory discrepancy. What should you do?
A person drops ott 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
Call the prescriber to verify the quantity
receives a quantity of 60, not 160. You review the prescrip-
tion and have concerns about possible forgery. What is
your next step?
Which of the following requires intent to obtain payment
Fraud
and the knowledge the actions are wrong?
You are in charge of paying claims submitted by providers.
You notice a certain diagnostic provider ("Doe Diagnos-
Consult with your immediate supervisor for next steps
tics") requested a substantial payment for a large patient
or contact the compliance department (via compliance
group. Many of these claims are for a certain procedure.
You review the same type of procedure for other diag-
2/6
Graded A+
Under ACA Section 1557, a health plan premium sold
through a state exchange may, based on an individual's charge higher premiums.
age and
As a result of violations of ACA Section 1557 nondiscrimi- a health plan may revoke an agent or broker's appoint-
nation rules, ment with the health plan.
policies and procedures, physical access, and communi-
ACA Section 1557 rules for disability concern
cation.
Which Medicare programs are covered by ACA Section
Parts A, C, and D, and Part B.
1557 under the Biden Administration's Final Rule (2024)?
Section 1557 incorporates earlier civil rights protections
Which of the following statements best describes Section
in regard to race, color, national origin, disability, age and
1557 of the Attordable Care Act (ACA)?
sex.
all health programs and activities administered by or re-
Section 1557 of the Attordable Care Act applies to
ceiving federal financial assistance from HHS.
Broker Mary Jones has recruited a diverse workforce. She
Which of the following would be considered permissible encourages her agents to prospect through communi-
under Section 1557? ty-based marketing and within their community of influ-
ence.
Which of these actions is most likely to be permitted in
Allowing a child to interpret in an emergency.
dealing with a person with limited English proficiency?
Which of the following statements best describes the Entities principally engaged in health care, which includes
scope of operations subject to Section 1557 under the health insurers, must comply with Section 1557 for all
Final Rule (2024) of the Biden Administration? programs they otter.
For a health plan, what are the possible consequences of
Loss of federal business and compensatory damages.
violations of ACA Section 1557?
Auxiliary aids and services must be provided to individ-
uals with disabilities, such as those suttering from vision
or hearing impairments, free of charge, and in a timely
1/6
, AHIP - Discrimination, Fraud, Waste, & Abuse – 2026 Questions with Answers
Graded A+
manner. Auxiliary aids and services include which of the
following:
I. large print materials
I, II, III, and IV
II. qualified sign language interpreters
III. braille materials and displays
IV. screen reader software
cannot deny coverage to LEP individuals and is required
Under ACA Section 1557, a health plan
to provide language assistance to them, free of charge.
Under Section 1557, the 2020 Final Rule issued dur-
as biologic sex only, meaning whether a person was de-
ing the Trump Administration sex was initially de-
termined to be male or female at birth.
fined
Which entity enforces Section 1557 for programs that
The Oflce of Civil Rights (OCR) of HHS.
receive funding from and are administered by HHS?
You are performing a regular inventory of the controlled
substances in the pharmacy. You discover a minor inven- Follow your pharmacy's procedures.
tory discrepancy. What should you do?
A person drops ott 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
Call the prescriber to verify the quantity
receives a quantity of 60, not 160. You review the prescrip-
tion and have concerns about possible forgery. What is
your next step?
Which of the following requires intent to obtain payment
Fraud
and the knowledge the actions are wrong?
You are in charge of paying claims submitted by providers.
You notice a certain diagnostic provider ("Doe Diagnos-
Consult with your immediate supervisor for next steps
tics") requested a substantial payment for a large patient
or contact the compliance department (via compliance
group. Many of these claims are for a certain procedure.
You review the same type of procedure for other diag-
2/6
