2025 AHIP - Fraud, Waste, And Abuse
Questions With Correct Answers
Which cof cthe cfollowing crequires cintent cto cobtain cpayment cand cthe cknowledge cthe
cactions care cwrong? c- cCORRECT cANS✔✔Fraud
Your cjob cis cto csubmit ca crisk cdiagnosis cto cthe cCenters cfor cMedicare c& cMedicaid
cServices c(CMS) cfor cthe cpurpose cof cpayment. cAs cpart cof cthis cjob, cyou cuse ca
cprocess cto cverify cthe cdata cis caccurate. cYour cimmediate csupervisor ctells cyou cto
cignore cthe cSponsor's cprocess cand cto cadjust cor cadd crisk cdiagnosis ccodes cfor
ccertain cindividuals. cWhat cshould cyou cdo? c- cCORRECT cANS✔✔Report cthe cincident
cto cthe ccompliance cdepartment c(via ccompliance chotline cor cother cmechanism)
Which cof cthe cfollowing cis cNOT cpotentially ca cpenalty cfor cviolation cof ca claw cor
cregulation cprohibiting cfraud, cwaste, cand cabuse c(FWA)? c- cCORRECT
cANS✔✔Deportation
You care cperforming ca cregular cinventory cof cthe ccontrolled csubstances cin cthe
cpharmacy. cYou cdiscover ca cminor cinventory cdiscrepancy. cWhat cshould cyou cdo? c-
cCORRECT cANS✔✔Follow cyour cpharmacy's cprocedures.
A cperson cdrops coff ca cprescription cfor ca cbeneficiary cwho cis ca c"regular" ccustomer.
cThe cprescription cis cfor ca ccontrolled csubstance cwith ca cquantity cof c160. cThis
cbeneficiary cnormally creceives ca cquantity cof c60, cnot c160. cYou creview cthe
cprescription cand chave cconcerns cabout cpossible cforgery. cWhat cis cyour cnext cstep? c-
cCORRECT cANS✔✔Call cthe cprescriber cto cverify cthe cquantity
You care cin ccharge cof cpaying cclaims csubmitted cby cproviders. cYou cnotice ca ccertain
cdiagnostic cprovider c("Doe cDiagnostics") crequested ca csubstantial cpayment cfor ca
clarge cpatient cgroup. cMany cof cthese cclaims care cfor ca ccertain cprocedure. cYou
creview cthe csame ctype cof cprocedure cfor cother cdiagnostic cproviders cand crealize
cDoe cDiagnostics' cclaims cfar cexceed cany cother cprovider cyou creviewed. cWhat
cshould cyou cdo? c- cCORRECT cANS✔✔Consult cwith cyour cimmediate csupervisor cfor
cnext csteps cor ccontact cthe ccompliance cdepartment c(via ccompliance chotline, cSpecial
cInvestigations cUnit c[SIU], cor cother cmechanism)
Questions With Correct Answers
Which cof cthe cfollowing crequires cintent cto cobtain cpayment cand cthe cknowledge cthe
cactions care cwrong? c- cCORRECT cANS✔✔Fraud
Your cjob cis cto csubmit ca crisk cdiagnosis cto cthe cCenters cfor cMedicare c& cMedicaid
cServices c(CMS) cfor cthe cpurpose cof cpayment. cAs cpart cof cthis cjob, cyou cuse ca
cprocess cto cverify cthe cdata cis caccurate. cYour cimmediate csupervisor ctells cyou cto
cignore cthe cSponsor's cprocess cand cto cadjust cor cadd crisk cdiagnosis ccodes cfor
ccertain cindividuals. cWhat cshould cyou cdo? c- cCORRECT cANS✔✔Report cthe cincident
cto cthe ccompliance cdepartment c(via ccompliance chotline cor cother cmechanism)
Which cof cthe cfollowing cis cNOT cpotentially ca cpenalty cfor cviolation cof ca claw cor
cregulation cprohibiting cfraud, cwaste, cand cabuse c(FWA)? c- cCORRECT
cANS✔✔Deportation
You care cperforming ca cregular cinventory cof cthe ccontrolled csubstances cin cthe
cpharmacy. cYou cdiscover ca cminor cinventory cdiscrepancy. cWhat cshould cyou cdo? c-
cCORRECT cANS✔✔Follow cyour cpharmacy's cprocedures.
A cperson cdrops coff ca cprescription cfor ca cbeneficiary cwho cis ca c"regular" ccustomer.
cThe cprescription cis cfor ca ccontrolled csubstance cwith ca cquantity cof c160. cThis
cbeneficiary cnormally creceives ca cquantity cof c60, cnot c160. cYou creview cthe
cprescription cand chave cconcerns cabout cpossible cforgery. cWhat cis cyour cnext cstep? c-
cCORRECT cANS✔✔Call cthe cprescriber cto cverify cthe cquantity
You care cin ccharge cof cpaying cclaims csubmitted cby cproviders. cYou cnotice ca ccertain
cdiagnostic cprovider c("Doe cDiagnostics") crequested ca csubstantial cpayment cfor ca
clarge cpatient cgroup. cMany cof cthese cclaims care cfor ca ccertain cprocedure. cYou
creview cthe csame ctype cof cprocedure cfor cother cdiagnostic cproviders cand crealize
cDoe cDiagnostics' cclaims cfar cexceed cany cother cprovider cyou creviewed. cWhat
cshould cyou cdo? c- cCORRECT cANS✔✔Consult cwith cyour cimmediate csupervisor cfor
cnext csteps cor ccontact cthe ccompliance cdepartment c(via ccompliance chotline, cSpecial
cInvestigations cUnit c[SIU], cor cother cmechanism)
