AHIP FWA Questions and Answers with
Certified Solutions
Which of the following requires intent to obtain payment and the knowledge that the actions are
wrong? ✔✔Fraud
Which of the following is NOT potentially a penalty for violation of a law or regulation
prohibiting Fraud, Waste, and Abuse (FWA)? ✔✔Deportation
A person comes to your pharmacy to drop 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? ✔✔Call the prescriber to verify the quantity
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 verify, through a certain process, that the data
is accurate. Your immediate supervisor tells you to ignore the Sponsor's process and to
adjust/add risk diagnosis codes for certain individuals. What should you do? ✔✔Report the
incident to the compliance department (via compliance hotline or other mechanism
Certified Solutions
Which of the following requires intent to obtain payment and the knowledge that the actions are
wrong? ✔✔Fraud
Which of the following is NOT potentially a penalty for violation of a law or regulation
prohibiting Fraud, Waste, and Abuse (FWA)? ✔✔Deportation
A person comes to your pharmacy to drop 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? ✔✔Call the prescriber to verify the quantity
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 verify, through a certain process, that the data
is accurate. Your immediate supervisor tells you to ignore the Sponsor's process and to
adjust/add risk diagnosis codes for certain individuals. What should you do? ✔✔Report the
incident to the compliance department (via compliance hotline or other mechanism
