AHFI Exam Questions & Answers | 100% Verified solutions (2026) UPDATE
|2026!! STUDY GUIDE EXAM
1. Anti-Kickback Prohibits offering, paying, soliciting or reviving anything of value to induce or
Statute (42 US SS reward referrals or generate Federal health care program business
1320a-7b (b)
prohibitions
2. Anti-Kickback Referrals from anyone
Statute (42 US SS
1320a-7b (b)
referrals
3. Anti-Kickback Any items or services
Statute (42 US SS
1320a-7b (b)
4. Anti-Kickback Intent MUST be proven (knowing and willful)
Statute (42 US SS
1320a-7b (b)
(Intent)
5. Anti-Kickback Fines up to $25,000/violation
Statute (42 US SS
1320a-7b (b) Up to a 5-yr prison term/violation
Criminal
penalties
6. Anti-Kickback False Claims act liability
Statute (42 US SS
1320a-7b (b) Civil monetary penalties and program exclusions
(Civil/administra-
Potential $50,000 CMP/violation
tive)
Civil assessment of up to 3x amount of kickback
, AHFI Exam Questions & Answers | 100% Verified solutions (2026) UPDATE
|2026!! STUDY GUIDE EXAM
7. Anti-Kickback Voluntary safe harbors
Statute (42 US SS
1320a-7b (b)
Exceptions
8. Anti-Kickback All Federal Health Care Programs
Statute (42 US SS
1320a-7b (b) -
what it applies
to...
9. The Stark Law (42 Prohibits a physician from referring Medicare patients for designated health
US SS 139nn) Pro- services to an entity with which the physician (or immediate family member) has
hibition a financial relationship, unless an exception applies)
Prohibits the designated health services entity from submitting claims to Medicare
for those services resulting from a prohibited referral
10. The Stark Law (42 Referrals from a physician
US SS 139nn) Re-
ferrals
11. The Stark Law Designated health services
(42 US SS 139nn)
(Items/Services)
12. The Stark Law (42 No intent standard for overpayment (strict liability)
US SS 139nn) (In-
tent) Intent required for civil monetary penalties for knowing violations
13. The Stark Law Overpayment/refund obligation
(42 US SS 139nn)
False Claims Act liability
, AHFI Exam Questions & Answers | 100% Verified solutions (2026) UPDATE
|2026!! STUDY GUIDE EXAM
(Civil Penalties)
only Civil monetary penalties and program exclusion for knowing violations
Potential $15,000 CMP for each service
Civil assessment of up to 3x the amount claimed.
14. The Stark Law (42 Mandatory exceptions
US SS 139nn) (Ex-
ceptions)
15. The Stark Law (42 Medicare and Medicaid
US SS 139nn) ap-
plies to (No commercial or tricare)
16. MACs: Medicare Administrative Contractors
They analyze claims to determine provider compliance with Medicare coverage,
coding, and billing rules and take appropriate corrective action when providers
are found to be non-compliant.
17. The goal of To correct the behavior in need of change and prevent future inappropriate billing
Mac administra-
tive actions
18. The priority of To minimize potential future losses to the Medicare Trust Fund through targeted
MACs claims review while using resource efficiently and treating providers and benefi-
ciaries fairly.
19. For repeated in- The discretion to initiate progressively more severe administrative action, com-
fractions, MACs mensurate with the seriousness of the identified problem. (See Program Integrity
have Manual (PIM) chapter 3, SS3. 7.1)
|2026!! STUDY GUIDE EXAM
1. Anti-Kickback Prohibits offering, paying, soliciting or reviving anything of value to induce or
Statute (42 US SS reward referrals or generate Federal health care program business
1320a-7b (b)
prohibitions
2. Anti-Kickback Referrals from anyone
Statute (42 US SS
1320a-7b (b)
referrals
3. Anti-Kickback Any items or services
Statute (42 US SS
1320a-7b (b)
4. Anti-Kickback Intent MUST be proven (knowing and willful)
Statute (42 US SS
1320a-7b (b)
(Intent)
5. Anti-Kickback Fines up to $25,000/violation
Statute (42 US SS
1320a-7b (b) Up to a 5-yr prison term/violation
Criminal
penalties
6. Anti-Kickback False Claims act liability
Statute (42 US SS
1320a-7b (b) Civil monetary penalties and program exclusions
(Civil/administra-
Potential $50,000 CMP/violation
tive)
Civil assessment of up to 3x amount of kickback
, AHFI Exam Questions & Answers | 100% Verified solutions (2026) UPDATE
|2026!! STUDY GUIDE EXAM
7. Anti-Kickback Voluntary safe harbors
Statute (42 US SS
1320a-7b (b)
Exceptions
8. Anti-Kickback All Federal Health Care Programs
Statute (42 US SS
1320a-7b (b) -
what it applies
to...
9. The Stark Law (42 Prohibits a physician from referring Medicare patients for designated health
US SS 139nn) Pro- services to an entity with which the physician (or immediate family member) has
hibition a financial relationship, unless an exception applies)
Prohibits the designated health services entity from submitting claims to Medicare
for those services resulting from a prohibited referral
10. The Stark Law (42 Referrals from a physician
US SS 139nn) Re-
ferrals
11. The Stark Law Designated health services
(42 US SS 139nn)
(Items/Services)
12. The Stark Law (42 No intent standard for overpayment (strict liability)
US SS 139nn) (In-
tent) Intent required for civil monetary penalties for knowing violations
13. The Stark Law Overpayment/refund obligation
(42 US SS 139nn)
False Claims Act liability
, AHFI Exam Questions & Answers | 100% Verified solutions (2026) UPDATE
|2026!! STUDY GUIDE EXAM
(Civil Penalties)
only Civil monetary penalties and program exclusion for knowing violations
Potential $15,000 CMP for each service
Civil assessment of up to 3x the amount claimed.
14. The Stark Law (42 Mandatory exceptions
US SS 139nn) (Ex-
ceptions)
15. The Stark Law (42 Medicare and Medicaid
US SS 139nn) ap-
plies to (No commercial or tricare)
16. MACs: Medicare Administrative Contractors
They analyze claims to determine provider compliance with Medicare coverage,
coding, and billing rules and take appropriate corrective action when providers
are found to be non-compliant.
17. The goal of To correct the behavior in need of change and prevent future inappropriate billing
Mac administra-
tive actions
18. The priority of To minimize potential future losses to the Medicare Trust Fund through targeted
MACs claims review while using resource efficiently and treating providers and benefi-
ciaries fairly.
19. For repeated in- The discretion to initiate progressively more severe administrative action, com-
fractions, MACs mensurate with the seriousness of the identified problem. (See Program Integrity
have Manual (PIM) chapter 3, SS3. 7.1)
