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AHIP Module 4, Fraud Waste and Abuse Prevention, Medicare Compliance Training Material

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This document covers AHIP Module 4 and focuses on identifying, preventing, and reporting fraud, waste, and abuse within the Medicare program. It explains common FWA schemes, compliance responsibilities, reporting procedures, and penalties, supporting thorough preparation for AHIP certification and compliance requirements. Keywords: AHIP Module 4 fraud waste and abuse Medicare FWA training AHIP compliance FWA prevention Medicare reporting procedures healthcare fraud prevention AHIP certification study Medicare compliance training

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AHIP MODULE 4 | QUESTIONS AND VERIFIED 100%
CORRECT ANSWERS| LATEST UPDATE 2026/2027 |
GRADED A+

This year you have decided to focus your efforts on marketing to employer group plans.
One employer provides you with a list of their retirees and asks you to contact them to
explain the characteristics of the plan they have selected. What should you do?
- ANSWER: You may go ahead and call them.


Winthrop Brokerage wishes to place an advertisement in the local newspaper that says:
"We offer Medicare Advantage plans offered by AB Health and Top Choice Health.
Contact us if you would like to learn more." Which of the following best describes the
obligation(s) of Winthrop Brokerage regarding the advertisement?
- ANSWER: Winthrop Brokerage does not need to submit the advertisement to CMS for
prior approval because it does not include information about the plans' benefits structures,
cost-sharing, or information about measures or ranking standards.


BestCare Health Plan has received a request from a state insurance department in
connection with the investigation of several marketing representatives licensed by the
state who sell Medicare Advantage plans. What action(s) should BestCare take in
response?
- ANSWER: Cooperate with the state and supply requested information.


During a sales presentation to Ms. Daley for a Medicare Advantage plan that has a 5-star
rating in customer service and care coordination, and received an overall plan
performance rating of a 4-star, which of the following would be the best statement to say
to her?
- ANSWER: The Medicare Advantage plan received a 5-star rating in customer service
and care coordination with an overall performance rating of 4-stars.


You market many different types of insurance and ordinarily you spend time each
evening calling potential clients. To comply with requirements for marketing Medicare

, Advantage and Part D plans, what must you do about contacting potential clients to
market those plans?
- ANSWER: You will have to avoid calling any potential client unless he or she initiates
contact with you and specifically asks that you give him or her a call.


While making an appointment to discuss Medicare Advantage (MA) and Part D plans
with a potential enrollee, you are asked to describe other types of insurance products that
your client might wish to purchase. What additional types of insurance can you present
during the MA and Part D marketing appointment?
- ANSWER: You can present only health care related lines of business but must obtain
the beneficiary's permission to do so before the presentation occurs and document that
you have obtained that permission.


If you are to comply with Medicare's guidance regarding educational events, which of the
following would be acceptable activities?
- ANSWER: You may distribute business cards to individuals who request information on
how to contact you for further details on the plan(s) you represent.


You plan to participate in an educational event sponsored by a large regional health care
system. One of your colleagues suggests that you do a presentation on one of the
Medicare Health plans you market and modify it to include information about preventive
screening tests showcased at the event. How should you respond to your colleague's
suggestion?
- ANSWER: You should tell your colleague no, because participation in an educational
event may not include a sales presentation.


By contacting plans available in your area, you have learned that the plan you represent
has a significantly lower monthly premium than the others. Furthermore, you see that the
plan you represent has a unique benefits package. What should you do to make sure your
clients know about these pieces of information?
- ANSWER: You may make comparisons between plans if you can support them by
studies or statistical data and such comparisons are factually based.

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Uploaded on
January 27, 2026
Number of pages
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Written in
2025/2026
Type
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