ACCREDITED HEALTH CARE FRAUD
INVESTIGATOR (AHFI) EXAM PREP
COMPLETE QUESTIONS AND VERIFIED
SOLUTIONS LATEST UPDATE
1. Under the False Claims Act, the ‘scienter’ requirement for liability is met if the person acts
with:
A. Specific intent to defraud the government
B. Actual knowledge, deliberate ignorance, or reckless disregard
C. Negligence or poor bookkeeping practices
D. Malice and intent to cause physical harm
Answer: B
Conceptual Explanation: The False Claims Act (FCA) does not require specific intent to
defraud. It defines ‘knowing’ to include actual knowledge, deliberate ignorance, or reckless
disregard for the truth or falsity of the information.
2. Which federal statute is a ‘strict liability’ law, meaning no proof of intent to violate the law
is required?
A. Anti-Kickback Statute (AKS)
B. False Claims Act (FCA)
,C. Health Insurance Portability and Accountability Act (HIPAA)
D. Stark Law (Physician Self-Referral Law)
Answer: D
Conceptual Explanation: The Stark Law is a strict liability statute. If a financial
relationship exists that does not meet an exception, a violation has occurred regardless of
the parties’ intent.
3. In the context of medical coding, ‘unbundling’ is best described as:
A. Separating the components of a procedure and billing each separately to increase
reimbursement
B. Billing for services that were never provided to the patient
C. Reporting a higher level of service than was actually performed
D. Using a single code to describe a group of procedures
Answer: A
Conceptual Explanation: Unbundling, or fragmentation, involves billing multiple codes for
components of a procedure that should be reported with a single comprehensive code.
4. The ‘Safe Harbor’ regulations apply specifically to which of the following?
A. Stark Law
B. Anti-Kickback Statute
C. Civil Monetary Penalties Law
, D. Social Security Act Section 1128
Answer: B
Conceptual Explanation: Safe Harbors describe payment and business practices that,
although they potentially implicate the Anti-Kickback Statute, are not treated as offenses if
they meet specific criteria.
5. A qui tam action is a lawsuit brought by a private individual, known as a ‘relator’, on behalf
of:
A. A private insurance company
B. The Government
C. The American Medical Association
D. A class of patients
Answer: B
Conceptual Explanation: Qui tam provisions of the False Claims Act allow private citizens
to sue on behalf of the government and share in any recovered damages.
6. Which of the following describes ‘upcoding’ in the context of Evaluation and Management
(E&M) services?
A. Failing to document the chief complaint
B. Billing for a new patient visit for an established patient
C. Billing for a nurse visit when a physician saw the patient
INVESTIGATOR (AHFI) EXAM PREP
COMPLETE QUESTIONS AND VERIFIED
SOLUTIONS LATEST UPDATE
1. Under the False Claims Act, the ‘scienter’ requirement for liability is met if the person acts
with:
A. Specific intent to defraud the government
B. Actual knowledge, deliberate ignorance, or reckless disregard
C. Negligence or poor bookkeeping practices
D. Malice and intent to cause physical harm
Answer: B
Conceptual Explanation: The False Claims Act (FCA) does not require specific intent to
defraud. It defines ‘knowing’ to include actual knowledge, deliberate ignorance, or reckless
disregard for the truth or falsity of the information.
2. Which federal statute is a ‘strict liability’ law, meaning no proof of intent to violate the law
is required?
A. Anti-Kickback Statute (AKS)
B. False Claims Act (FCA)
,C. Health Insurance Portability and Accountability Act (HIPAA)
D. Stark Law (Physician Self-Referral Law)
Answer: D
Conceptual Explanation: The Stark Law is a strict liability statute. If a financial
relationship exists that does not meet an exception, a violation has occurred regardless of
the parties’ intent.
3. In the context of medical coding, ‘unbundling’ is best described as:
A. Separating the components of a procedure and billing each separately to increase
reimbursement
B. Billing for services that were never provided to the patient
C. Reporting a higher level of service than was actually performed
D. Using a single code to describe a group of procedures
Answer: A
Conceptual Explanation: Unbundling, or fragmentation, involves billing multiple codes for
components of a procedure that should be reported with a single comprehensive code.
4. The ‘Safe Harbor’ regulations apply specifically to which of the following?
A. Stark Law
B. Anti-Kickback Statute
C. Civil Monetary Penalties Law
, D. Social Security Act Section 1128
Answer: B
Conceptual Explanation: Safe Harbors describe payment and business practices that,
although they potentially implicate the Anti-Kickback Statute, are not treated as offenses if
they meet specific criteria.
5. A qui tam action is a lawsuit brought by a private individual, known as a ‘relator’, on behalf
of:
A. A private insurance company
B. The Government
C. The American Medical Association
D. A class of patients
Answer: B
Conceptual Explanation: Qui tam provisions of the False Claims Act allow private citizens
to sue on behalf of the government and share in any recovered damages.
6. Which of the following describes ‘upcoding’ in the context of Evaluation and Management
(E&M) services?
A. Failing to document the chief complaint
B. Billing for a new patient visit for an established patient
C. Billing for a nurse visit when a physician saw the patient
