AHIP Medicare Fraud, Waste and Abuse (MFWA)
Certification Exam New 2026 Version with All 50
Questions, 100% Correct Answers and Rationales
This is PASS-FOCUSED, not textbook fluff.
✅ AHIP MFWA – 20 TOUGHEST QUESTIONS
1. A provider accidentally submits a claim twice and immediately corrects it once discovered. What is
this?
A. Fraud
B. Waste
C. Abuse
D. Not FWA
✅ Correct Answer: D
Explanation:
Fraud requires intent. An accidental error corrected promptly is not Fraud, Waste, or Abuse.
2. A provider knowingly bills for services not rendered. This is considered:
A. Abuse
B. Waste
C. Fraud
D. Billing error
✅ Correct Answer: C
Explanation:
Billing for services not provided with knowledge = intentional deception → FRAUD.
3. Which element is REQUIRED to prove fraud?
A. Overutilization
B. Improper documentation
, C. Intent to deceive
D. Increased cost
✅ Correct Answer: C
4. A physician orders excessive diagnostic tests with no medical necessity, but no intent to deceive
exists. This is:
A. Fraud
B. Waste
C. Abuse
D. Negligence
✅ Correct Answer: B
5. A provider routinely upcodes visits without documentation but claims it was “habitual billing.” This
is MOST likely:
A. Waste
B. Abuse
C. Fraud
D. Error
✅ Correct Answer: B
Explanation:
Upcoding without intent proven = Abuse.
Intent proven = Fraud.
6. A Medicare beneficiary allows a family member to use their Medicare ID card. This is:
A. Abuse
B. Waste
C. Fraud
D. Acceptable if family
✅ Correct Answer: C
7. Which law prohibits offering gifts in exchange for Medicare referrals?
A. Stark Law
B. False Claims Act
Certification Exam New 2026 Version with All 50
Questions, 100% Correct Answers and Rationales
This is PASS-FOCUSED, not textbook fluff.
✅ AHIP MFWA – 20 TOUGHEST QUESTIONS
1. A provider accidentally submits a claim twice and immediately corrects it once discovered. What is
this?
A. Fraud
B. Waste
C. Abuse
D. Not FWA
✅ Correct Answer: D
Explanation:
Fraud requires intent. An accidental error corrected promptly is not Fraud, Waste, or Abuse.
2. A provider knowingly bills for services not rendered. This is considered:
A. Abuse
B. Waste
C. Fraud
D. Billing error
✅ Correct Answer: C
Explanation:
Billing for services not provided with knowledge = intentional deception → FRAUD.
3. Which element is REQUIRED to prove fraud?
A. Overutilization
B. Improper documentation
, C. Intent to deceive
D. Increased cost
✅ Correct Answer: C
4. A physician orders excessive diagnostic tests with no medical necessity, but no intent to deceive
exists. This is:
A. Fraud
B. Waste
C. Abuse
D. Negligence
✅ Correct Answer: B
5. A provider routinely upcodes visits without documentation but claims it was “habitual billing.” This
is MOST likely:
A. Waste
B. Abuse
C. Fraud
D. Error
✅ Correct Answer: B
Explanation:
Upcoding without intent proven = Abuse.
Intent proven = Fraud.
6. A Medicare beneficiary allows a family member to use their Medicare ID card. This is:
A. Abuse
B. Waste
C. Fraud
D. Acceptable if family
✅ Correct Answer: C
7. Which law prohibits offering gifts in exchange for Medicare referrals?
A. Stark Law
B. False Claims Act
