AHFI EXAM QUESTIONS AND ANSWERS
2026 VERIFIED.
Anti-Kickback Statute (42 US SS 1320a-7b (b) prohibitions - ANS Prohibits offering, paying,
soliciting or reviving anything of value to induce or reward referrals or generate Federal health
care program business
Anti-Kickback Statute (42 US SS 1320a-7b (b) referrals - ANS Referrals from anyone
Anti-Kickback Statute (42 US SS 1320a-7b (b) - ANS Any items or services
Anti-Kickback Statute (42 US SS 1320a-7b (b) (Intent) - ANS Intent MUST be proven (knowing
and willful)
Anti-Kickback Statute (42 US SS 1320a-7b (b) Criminal penalties - ANS Fines up to
$25,000/violation
Up to a 5-yr prison term/violation
Anti-Kickback Statute (42 US SS 1320a-7b (b) (Civil/administrative) - ANS False Claims act
liability
Civil monetary penalties and program exclusions
@2026/2027 ALLRIGHTS RESERVED.
,Potential $50,000 CMP/violation
Civil assessment of up to 3x amount of kickback
Anti-Kickback Statute (42 US SS 1320a-7b (b) Exceptions - ANS Voluntary safe harbors
Anti-Kickback Statute (42 US SS 1320a-7b (b) - what it applies to... - ANS All Federal Health
Care Programs
The Stark Law (42 US SS 139nn) Prohibition - ANS Prohibits a physician from referring
Medicare patients for designated health services to an entity with which the physician (or
immediate family member) has 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
The Stark Law (42 US SS 139nn) Referrals - ANS Referrals from a physician
The Stark Law (42 US SS 139nn) (Items/Services) - ANS Designated health services
The Stark Law (42 US SS 139nn) (Intent) - ANS No intent standard for overpayment (strict
liability)
Intent required for civil monetary penalties for knowing violations
The Stark Law (42 US SS 139nn) (Civil Penalties) only - ANS Overpayment/refund obligation
False Claims Act liability
@2026/2027 ALLRIGHTS RESERVED.
, 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.
The Stark Law (42 US SS 139nn) (Exceptions) - ANS Mandatory exceptions
The Stark Law (42 US SS 139nn) applies to - ANS Medicare and Medicaid
(No commercial or tricare)
MACs: - ANS 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.
The goal of Mac administrative actions - ANS To correct the behavior in need of change and
prevent future inappropriate billing
The priority of MACs - ANS To minimize potential future losses to the Medicare Trust Fund
through targeted claims review while using resource efficiently and treating providers and
beneficiaries fairly.
For repeated infractions, MACs have - ANS The discretion to initiate progressively more
severe administrative action, commensurate with the seriousness of the identified problem.
(See Program Integrity Manual (PIM) chapter 3, SS3. 7.1)
@2026/2027 ALLRIGHTS RESERVED.
2026 VERIFIED.
Anti-Kickback Statute (42 US SS 1320a-7b (b) prohibitions - ANS Prohibits offering, paying,
soliciting or reviving anything of value to induce or reward referrals or generate Federal health
care program business
Anti-Kickback Statute (42 US SS 1320a-7b (b) referrals - ANS Referrals from anyone
Anti-Kickback Statute (42 US SS 1320a-7b (b) - ANS Any items or services
Anti-Kickback Statute (42 US SS 1320a-7b (b) (Intent) - ANS Intent MUST be proven (knowing
and willful)
Anti-Kickback Statute (42 US SS 1320a-7b (b) Criminal penalties - ANS Fines up to
$25,000/violation
Up to a 5-yr prison term/violation
Anti-Kickback Statute (42 US SS 1320a-7b (b) (Civil/administrative) - ANS False Claims act
liability
Civil monetary penalties and program exclusions
@2026/2027 ALLRIGHTS RESERVED.
,Potential $50,000 CMP/violation
Civil assessment of up to 3x amount of kickback
Anti-Kickback Statute (42 US SS 1320a-7b (b) Exceptions - ANS Voluntary safe harbors
Anti-Kickback Statute (42 US SS 1320a-7b (b) - what it applies to... - ANS All Federal Health
Care Programs
The Stark Law (42 US SS 139nn) Prohibition - ANS Prohibits a physician from referring
Medicare patients for designated health services to an entity with which the physician (or
immediate family member) has 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
The Stark Law (42 US SS 139nn) Referrals - ANS Referrals from a physician
The Stark Law (42 US SS 139nn) (Items/Services) - ANS Designated health services
The Stark Law (42 US SS 139nn) (Intent) - ANS No intent standard for overpayment (strict
liability)
Intent required for civil monetary penalties for knowing violations
The Stark Law (42 US SS 139nn) (Civil Penalties) only - ANS Overpayment/refund obligation
False Claims Act liability
@2026/2027 ALLRIGHTS RESERVED.
, 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.
The Stark Law (42 US SS 139nn) (Exceptions) - ANS Mandatory exceptions
The Stark Law (42 US SS 139nn) applies to - ANS Medicare and Medicaid
(No commercial or tricare)
MACs: - ANS 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.
The goal of Mac administrative actions - ANS To correct the behavior in need of change and
prevent future inappropriate billing
The priority of MACs - ANS To minimize potential future losses to the Medicare Trust Fund
through targeted claims review while using resource efficiently and treating providers and
beneficiaries fairly.
For repeated infractions, MACs have - ANS The discretion to initiate progressively more
severe administrative action, commensurate with the seriousness of the identified problem.
(See Program Integrity Manual (PIM) chapter 3, SS3. 7.1)
@2026/2027 ALLRIGHTS RESERVED.
