2025 AHIP - Fraud, Waste, And Abuse
Questions And Answers Latest Top Score.
Which fof fthe ffollowing frequires fintent fto fobtain fpayment fand fthe fknowledge fthe factions
fare fwrong? f- fVerified fANS f✔✔ f f- f fFraud
Your fjob fis fto fsubmit fa frisk fdiagnosis fto fthe fCenters ffor fMedicare f& fMedicaid fServices
f(CMS) ffor fthe fpurpose fof fpayment. fAs fpart fof fthis fjob, fyou fuse fa fprocess fto fverify fthe
fdata fis faccurate. fYour fimmediate fsupervisor ftells fyou fto fignore fthe fSponsor's fprocess
fand fto fadjust for fadd frisk fdiagnosis fcodes ffor fcertain findividuals. fWhat fshould fyou fdo? f-
fVerified fANS f✔✔ f f- f fReport fthe fincident fto fthe fcompliance fdepartment f(via fcompliance
fhotline for fother fmechanism)
Which fof fthe ffollowing fis fNOT fpotentially fa fpenalty ffor fviolation fof fa flaw for fregulation
fprohibiting ffraud, fwaste, fand fabuse f(FWA)? f- fVerified fANS f✔✔ f f- f fDeportation
You fare fperforming fa fregular finventory fof fthe fcontrolled fsubstances fin fthe fpharmacy.
fYou fdiscover fa fminor finventory fdiscrepancy. fWhat fshould fyou fdo? f- fVerified fANS f✔✔ f f- f
fFollow fyour fpharmacy's fprocedures.
A fperson fdrops foff fa fprescription ffor fa fbeneficiary fwho fis fa f"regular" fcustomer. fThe
fprescription fis ffor fa fcontrolled fsubstance fwith fa fquantity fof f160. fThis fbeneficiary fnormally
freceives fa fquantity fof f60, fnot f160. fYou freview fthe fprescription fand fhave fconcerns fabout
fpossible fforgery. fWhat fis fyour fnext fstep? f- fVerified fANS f✔✔ f f- f fCall fthe fprescriber fto
fverify fthe fquantity
You fare fin fcharge fof fpaying fclaims fsubmitted fby fproviders. fYou fnotice fa fcertain
fdiagnostic fprovider f("Doe fDiagnostics") frequested fa fsubstantial fpayment ffor fa flarge
fpatient fgroup. fMany fof fthese fclaims fare ffor fa fcertain fprocedure. fYou freview fthe fsame
ftype fof fprocedure ffor fother fdiagnostic fproviders fand frealize fDoe fDiagnostics' fclaims ffar
fexceed fany fother fprovider fyou freviewed. fWhat fshould fyou fdo? f- fVerified fANS f✔✔ f f- f
fConsult fwith fyour fimmediate fsupervisor ffor fnext fsteps for fcontact fthe fcompliance
fdepartment f(via fcompliance fhotline, fSpecial fInvestigations fUnit f[SIU], for fother
fmechanism)
Bribes for fkickbacks fof fany fkind ffor fservices fthat fare fpaid funder fa fFederal fhealth fcare
fprogram f(which fincludes fMedicare) fconstitute ffraud fby fthe fperson fmaking fas fwell fas fthe
fperson freceiving fthem. f- fVerified fANS f✔✔ f f- f fTrue
Questions And Answers Latest Top Score.
Which fof fthe ffollowing frequires fintent fto fobtain fpayment fand fthe fknowledge fthe factions
fare fwrong? f- fVerified fANS f✔✔ f f- f fFraud
Your fjob fis fto fsubmit fa frisk fdiagnosis fto fthe fCenters ffor fMedicare f& fMedicaid fServices
f(CMS) ffor fthe fpurpose fof fpayment. fAs fpart fof fthis fjob, fyou fuse fa fprocess fto fverify fthe
fdata fis faccurate. fYour fimmediate fsupervisor ftells fyou fto fignore fthe fSponsor's fprocess
fand fto fadjust for fadd frisk fdiagnosis fcodes ffor fcertain findividuals. fWhat fshould fyou fdo? f-
fVerified fANS f✔✔ f f- f fReport fthe fincident fto fthe fcompliance fdepartment f(via fcompliance
fhotline for fother fmechanism)
Which fof fthe ffollowing fis fNOT fpotentially fa fpenalty ffor fviolation fof fa flaw for fregulation
fprohibiting ffraud, fwaste, fand fabuse f(FWA)? f- fVerified fANS f✔✔ f f- f fDeportation
You fare fperforming fa fregular finventory fof fthe fcontrolled fsubstances fin fthe fpharmacy.
fYou fdiscover fa fminor finventory fdiscrepancy. fWhat fshould fyou fdo? f- fVerified fANS f✔✔ f f- f
fFollow fyour fpharmacy's fprocedures.
A fperson fdrops foff fa fprescription ffor fa fbeneficiary fwho fis fa f"regular" fcustomer. fThe
fprescription fis ffor fa fcontrolled fsubstance fwith fa fquantity fof f160. fThis fbeneficiary fnormally
freceives fa fquantity fof f60, fnot f160. fYou freview fthe fprescription fand fhave fconcerns fabout
fpossible fforgery. fWhat fis fyour fnext fstep? f- fVerified fANS f✔✔ f f- f fCall fthe fprescriber fto
fverify fthe fquantity
You fare fin fcharge fof fpaying fclaims fsubmitted fby fproviders. fYou fnotice fa fcertain
fdiagnostic fprovider f("Doe fDiagnostics") frequested fa fsubstantial fpayment ffor fa flarge
fpatient fgroup. fMany fof fthese fclaims fare ffor fa fcertain fprocedure. fYou freview fthe fsame
ftype fof fprocedure ffor fother fdiagnostic fproviders fand frealize fDoe fDiagnostics' fclaims ffar
fexceed fany fother fprovider fyou freviewed. fWhat fshould fyou fdo? f- fVerified fANS f✔✔ f f- f
fConsult fwith fyour fimmediate fsupervisor ffor fnext fsteps for fcontact fthe fcompliance
fdepartment f(via fcompliance fhotline, fSpecial fInvestigations fUnit f[SIU], for fother
fmechanism)
Bribes for fkickbacks fof fany fkind ffor fservices fthat fare fpaid funder fa fFederal fhealth fcare
fprogram f(which fincludes fMedicare) fconstitute ffraud fby fthe fperson fmaking fas fwell fas fthe
fperson freceiving fthem. f- fVerified fANS f✔✔ f f- f fTrue
