2027 AHIP Fraud, Waste, and Abuse (FWA)
Exam | Practice Questions & Verified
Answers | Complete Exam Prep
1. Which of the following requires intent to obtain payment and the knowledge the actions are
wrong?
A) Waste
B) Abuse
C) Fraud
D) Negligence
Answer C: Fraud
Rationale: Fraud requires intent to obtain payment and knowledge that the actions are wrong. ---
2. 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 use a process to verify the data is accurate. Your
immediate supervisor tells you to ignore the Sponsor's process and to adjust or add risk diagnosis
codes for certain individuals. What should you do?
A) Follow your supervisor's instructions
B) Report the incident to the compliance department (via compliance hotline or other mechanism)
C) Ignore the supervisor's request and continue working
D) Ask a coworker for advice
Answer B: Report the incident to the compliance department (via compliance hotline or other
mechanism)
Rationale: Suspected fraud or unethical instructions must be reported to the compliance department. ---
, 3. Which of the following is NOT potentially a penalty for violation of a law or regulation
prohibiting fraud, waste, and abuse (FWA)?
A) Imprisonment
B) Civil monetary penalties
C) Deportation
D) Exclusion from Federal health care programs
Answer C: Deportation
Rationale: Deportation is not a penalty for FWA violations; penalties include fines, imprisonment, and
exclusion. ---
4. You are performing a regular inventory of the controlled substances in the pharmacy. You
discover a minor inventory discrepancy. What should you do?
A) Ignore the discrepancy
B) Follow your pharmacy's procedures
C) Adjust the inventory records yourself
D) Notify the DEA immediately
Answer B: Follow your pharmacy's procedures
Rationale: Minor discrepancies should be handled per pharmacy policy, which may include
documentation and reporting. ---
5. A person drops 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?
A) Fill the prescription as written
B) Refuse to fill the prescription
C) Call the prescriber to verify the quantity
D) Report the customer to the police
Answer C: Call the prescriber to verify the quantity
Exam | Practice Questions & Verified
Answers | Complete Exam Prep
1. Which of the following requires intent to obtain payment and the knowledge the actions are
wrong?
A) Waste
B) Abuse
C) Fraud
D) Negligence
Answer C: Fraud
Rationale: Fraud requires intent to obtain payment and knowledge that the actions are wrong. ---
2. 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 use a process to verify the data is accurate. Your
immediate supervisor tells you to ignore the Sponsor's process and to adjust or add risk diagnosis
codes for certain individuals. What should you do?
A) Follow your supervisor's instructions
B) Report the incident to the compliance department (via compliance hotline or other mechanism)
C) Ignore the supervisor's request and continue working
D) Ask a coworker for advice
Answer B: Report the incident to the compliance department (via compliance hotline or other
mechanism)
Rationale: Suspected fraud or unethical instructions must be reported to the compliance department. ---
, 3. Which of the following is NOT potentially a penalty for violation of a law or regulation
prohibiting fraud, waste, and abuse (FWA)?
A) Imprisonment
B) Civil monetary penalties
C) Deportation
D) Exclusion from Federal health care programs
Answer C: Deportation
Rationale: Deportation is not a penalty for FWA violations; penalties include fines, imprisonment, and
exclusion. ---
4. You are performing a regular inventory of the controlled substances in the pharmacy. You
discover a minor inventory discrepancy. What should you do?
A) Ignore the discrepancy
B) Follow your pharmacy's procedures
C) Adjust the inventory records yourself
D) Notify the DEA immediately
Answer B: Follow your pharmacy's procedures
Rationale: Minor discrepancies should be handled per pharmacy policy, which may include
documentation and reporting. ---
5. A person drops 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?
A) Fill the prescription as written
B) Refuse to fill the prescription
C) Call the prescriber to verify the quantity
D) Report the customer to the police
Answer C: Call the prescriber to verify the quantity
