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AHIP FRAUD WASTE AND ABUSE EXAM NEWEST
2025 ACTUAL EXAM COMPLETE QUESTIONS AND
100% CORRECT DETAILED ANSWERS WITH
RATIONALES (VERIFIED ANSWERS) |ALREADY
GRADED A+/ LATEST EXAM!!!
Which of the following requires intent to obtain payment
and the knowledge the actions are wrong? - Answer-Fraud
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 use a process to verify
the data is accurate. Your immediate supervisor tells you
to ignore the Sponsor's process and to adjust or add risk
diagnosis codes for certain individuals. What should you
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do? - Answer-Report the incident to the compliance
department (via compliance hotline or other mechanism)
Which of the following is NOT potentially a penalty for
violation of a law or regulation prohibiting fraud, waste,
and abuse (FWA)? - Answer-Deportation
You are performing a regular inventory of the controlled
substances in the pharmacy. You discover a minor
inventory discrepancy. What should you do? - Answer-
Follow your pharmacy's procedures.
A person drops off a prescription for a beneficiary who is a
"regular" customer. The prescription is for a controlled
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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? - Answer-Call the prescriber to
verify the quantity
You are in charge of paying claims submitted by providers.
You notice a certain diagnostic provider ("Doe
Diagnostics") requested a substantial payment for a large
patient group. Many of these claims are for a certain
procedure. You review the same type of procedure for
other diagnostic providers and realize Doe Diagnostics'
claims far exceed any other provider you reviewed. What
should you do? - Answer-Consult with your immediate
supervisor for next steps or contact the compliance
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department (via compliance hotline, Special Investigations
Unit [SIU], or other mechanism)
Bribes or kickbacks of any kind for services that are paid
under a Federal health care program (which includes
Medicare) constitute fraud by the person making as well
as the person receiving them. - Answer-True
Some of the laws governing Medicare Part C and D fraud,
waste, and abuse (FWA) include the Health Insurance
Portability and Accountability Act (HIPAA), the Civil False
Claims Act, the Anti-Kickback Statute, and the Criminal
Health Care Fraud Statute. - Answer-True
AHIP FRAUD WASTE AND ABUSE EXAM NEWEST
2025 ACTUAL EXAM COMPLETE QUESTIONS AND
100% CORRECT DETAILED ANSWERS WITH
RATIONALES (VERIFIED ANSWERS) |ALREADY
GRADED A+/ LATEST EXAM!!!
Which of the following requires intent to obtain payment
and the knowledge the actions are wrong? - Answer-Fraud
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 use a process to verify
the data is accurate. Your immediate supervisor tells you
to ignore the Sponsor's process and to adjust or add risk
diagnosis codes for certain individuals. What should you
,2|Page
do? - Answer-Report the incident to the compliance
department (via compliance hotline or other mechanism)
Which of the following is NOT potentially a penalty for
violation of a law or regulation prohibiting fraud, waste,
and abuse (FWA)? - Answer-Deportation
You are performing a regular inventory of the controlled
substances in the pharmacy. You discover a minor
inventory discrepancy. What should you do? - Answer-
Follow your pharmacy's procedures.
A person drops off a prescription for a beneficiary who is a
"regular" customer. The prescription is for a controlled
,3|Page
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? - Answer-Call the prescriber to
verify the quantity
You are in charge of paying claims submitted by providers.
You notice a certain diagnostic provider ("Doe
Diagnostics") requested a substantial payment for a large
patient group. Many of these claims are for a certain
procedure. You review the same type of procedure for
other diagnostic providers and realize Doe Diagnostics'
claims far exceed any other provider you reviewed. What
should you do? - Answer-Consult with your immediate
supervisor for next steps or contact the compliance
, 4|Page
department (via compliance hotline, Special Investigations
Unit [SIU], or other mechanism)
Bribes or kickbacks of any kind for services that are paid
under a Federal health care program (which includes
Medicare) constitute fraud by the person making as well
as the person receiving them. - Answer-True
Some of the laws governing Medicare Part C and D fraud,
waste, and abuse (FWA) include the Health Insurance
Portability and Accountability Act (HIPAA), the Civil False
Claims Act, the Anti-Kickback Statute, and the Criminal
Health Care Fraud Statute. - Answer-True
