AHIP other
Study online at https://quizlet.com/_48df0c
1. Which of the following requires intent to obtain Fraud
payment and the knowledge that the actions are
wrong?
2. Which of the following is NOT potentially a penal- Deportation
ty for violation of a law or regulation prohibiting
Fraud, Waste, and Abuse (FWA)?
3. A person comes to your pharmacy to drop off a Call the prescriber to verify the
prescription for a beneficiary who is a "regular" quantity
customer. The prescription is for a controlled sub-
stance with a quantity of 160. This beneficiary nor-
mally receives a quantity of 60, not 160. You review
the prescription and have concerns about possible
forgery. What is your next step?
4. Your job is to submit a risk diagnosis to the Centers Report the incident to the com-
for Medicare & Medicaid Services (CMS) for the pliance department (via compli-
purpose of payment. As part of this job you verify, ance hotline or other mecha-
through a certain process, that the data is accurate. nism
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?
5. You are in charge of payment of claims submit- Consult with your immediate su-
ted by providers. You notice a certain diagnostic pervisor for next steps or contact
provider ("Doe Diagnostics") requested a substan- the compliance department (via
tial payment for a large number of members. Many compliance hotline, Special In-
of these claims are for a certain procedure. You vestigations Unit (SIU), or other
review the same type of procedure for other diag- mechanism)
nostic providers and realize that Doe Diagnostics'
1/3
Study online at https://quizlet.com/_48df0c
1. Which of the following requires intent to obtain Fraud
payment and the knowledge that the actions are
wrong?
2. Which of the following is NOT potentially a penal- Deportation
ty for violation of a law or regulation prohibiting
Fraud, Waste, and Abuse (FWA)?
3. A person comes to your pharmacy to drop off a Call the prescriber to verify the
prescription for a beneficiary who is a "regular" quantity
customer. The prescription is for a controlled sub-
stance with a quantity of 160. This beneficiary nor-
mally receives a quantity of 60, not 160. You review
the prescription and have concerns about possible
forgery. What is your next step?
4. Your job is to submit a risk diagnosis to the Centers Report the incident to the com-
for Medicare & Medicaid Services (CMS) for the pliance department (via compli-
purpose of payment. As part of this job you verify, ance hotline or other mecha-
through a certain process, that the data is accurate. nism
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?
5. You are in charge of payment of claims submit- Consult with your immediate su-
ted by providers. You notice a certain diagnostic pervisor for next steps or contact
provider ("Doe Diagnostics") requested a substan- the compliance department (via
tial payment for a large number of members. Many compliance hotline, Special In-
of these claims are for a certain procedure. You vestigations Unit (SIU), or other
review the same type of procedure for other diag- mechanism)
nostic providers and realize that Doe Diagnostics'
1/3
