AHIP PRACTICE SOLUTION 2026 ACTUAL
EXAM Q&A GRADED A+
◉ Which of the following is NOT potentially a penalty for violation of a
law or regulation prohibiting Fraud, Waste, and Abuse (FWA)? Answer:
Deportation
◉ A person comes to your pharmacy to drop off a prescription for a
beneficiary who is a "regular" customer. The prescription is for a
controlled 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
◉ 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 verify, through a certain process, that the data is accurate. Your
immediate supervisor tells you to ignore the Sponsor's process and to
adjust/add risk diagnosis codes for certain individuals. What should you
do? Answer: Report the incident to the compliance department (via
compliance hotline or other mechanism
◉ You are in charge of payment of claims submitted by providers. You
notice a certain diagnostic provider ("Doe Diagnostics") requested a
substantial payment for a large number of members. Many of these
claims are for a certain procedure. You review the same type of
EXAM Q&A GRADED A+
◉ Which of the following is NOT potentially a penalty for violation of a
law or regulation prohibiting Fraud, Waste, and Abuse (FWA)? Answer:
Deportation
◉ A person comes to your pharmacy to drop off a prescription for a
beneficiary who is a "regular" customer. The prescription is for a
controlled 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
◉ 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 verify, through a certain process, that the data is accurate. Your
immediate supervisor tells you to ignore the Sponsor's process and to
adjust/add risk diagnosis codes for certain individuals. What should you
do? Answer: Report the incident to the compliance department (via
compliance hotline or other mechanism
◉ You are in charge of payment of claims submitted by providers. You
notice a certain diagnostic provider ("Doe Diagnostics") requested a
substantial payment for a large number of members. Many of these
claims are for a certain procedure. You review the same type of
