ACCREDITED HEALTH CARE FRAUD
INVESTIGATOR (AHFI) FINAL
EXAMINATION STUDY GUIDE
COMPLETE QUESTIONS AND VERIFIED
SOLUTIONS LATEST UPDATE
1. Which legal doctrine states that the Anti-Kickback Statute is violated if even one purpose of
the remuneration is to induce referrals, regardless of other legitimate purposes?
A. The ‘Primary Motive’ Test
B. The ‘One Purpose’ Rule
C. The ‘Direct Link’ Doctrine
D. The ‘Sole Inducement’ Principle
Answer: B
Conceptual Explanation: Federal courts have consistently applied the ‘One Purpose’ Rule,
holding that the Anti-Kickback Statute is violated if just one purpose of a payment is to
induce referrals, even if the payment is also for legitimate services rendered.
2. Under the Stark Law, which of the following is a critical difference compared to the Anti-
Kickback Statute?
A. Stark Law requires proof of intent to defraud.
,B. Stark Law is a strict liability statute.
C. Stark Law only applies to Medicaid, not Medicare.
D. Stark Law carries criminal penalties rather than civil ones.
Answer: B
Conceptual Explanation: The Stark Law is a strict liability statute, meaning no proof of
intent to violate the law is required; if a financial relationship exists and an exception is not
met, a violation has occurred.
3. Regarding the False Claims Act (FCA), what does the ‘knowing’ standard encompass?
A. Only actual knowledge of the information.
B. Actual knowledge or simple negligence.
C. Specific intent to defraud the government.
D. Actual knowledge, deliberate ignorance, or reckless disregard.
Answer: D
Conceptual Explanation: The FCA defines ‘knowing’ to include actual knowledge,
deliberate ignorance of the truth, or reckless disregard for the truth or falsity of the
information. No specific intent to defraud is required.
4. In a ‘Qui Tam’ action under the False Claims Act, how long is the initial period the
complaint must remain under seal?
A. 30 days
, B. 45 days
C. 90 days
D. 60 days
Answer: D
Conceptual Explanation: Under the FCA, the complaint must be filed in camera and
remain under seal for at least 60 days to allow the DOJ to investigate the allegations before
the defendant is served.
5. Which modifier is most commonly associated with ‘unbundling’ fraud when used to bypass
National Correct Coding Initiative (NCCI) edits?
A. Modifier 59
B. Modifier 25
C. Modifier 22
D. Modifier 91
Answer: A
Conceptual Explanation: Modifier 59 is used to identify procedures/services that are
commonly bundled but are distinct in a specific case. Fraudulent use involves appending it
solely to bypass edits and receive separate payment.
INVESTIGATOR (AHFI) FINAL
EXAMINATION STUDY GUIDE
COMPLETE QUESTIONS AND VERIFIED
SOLUTIONS LATEST UPDATE
1. Which legal doctrine states that the Anti-Kickback Statute is violated if even one purpose of
the remuneration is to induce referrals, regardless of other legitimate purposes?
A. The ‘Primary Motive’ Test
B. The ‘One Purpose’ Rule
C. The ‘Direct Link’ Doctrine
D. The ‘Sole Inducement’ Principle
Answer: B
Conceptual Explanation: Federal courts have consistently applied the ‘One Purpose’ Rule,
holding that the Anti-Kickback Statute is violated if just one purpose of a payment is to
induce referrals, even if the payment is also for legitimate services rendered.
2. Under the Stark Law, which of the following is a critical difference compared to the Anti-
Kickback Statute?
A. Stark Law requires proof of intent to defraud.
,B. Stark Law is a strict liability statute.
C. Stark Law only applies to Medicaid, not Medicare.
D. Stark Law carries criminal penalties rather than civil ones.
Answer: B
Conceptual Explanation: The Stark Law is a strict liability statute, meaning no proof of
intent to violate the law is required; if a financial relationship exists and an exception is not
met, a violation has occurred.
3. Regarding the False Claims Act (FCA), what does the ‘knowing’ standard encompass?
A. Only actual knowledge of the information.
B. Actual knowledge or simple negligence.
C. Specific intent to defraud the government.
D. Actual knowledge, deliberate ignorance, or reckless disregard.
Answer: D
Conceptual Explanation: The FCA defines ‘knowing’ to include actual knowledge,
deliberate ignorance of the truth, or reckless disregard for the truth or falsity of the
information. No specific intent to defraud is required.
4. In a ‘Qui Tam’ action under the False Claims Act, how long is the initial period the
complaint must remain under seal?
A. 30 days
, B. 45 days
C. 90 days
D. 60 days
Answer: D
Conceptual Explanation: Under the FCA, the complaint must be filed in camera and
remain under seal for at least 60 days to allow the DOJ to investigate the allegations before
the defendant is served.
5. Which modifier is most commonly associated with ‘unbundling’ fraud when used to bypass
National Correct Coding Initiative (NCCI) edits?
A. Modifier 59
B. Modifier 25
C. Modifier 22
D. Modifier 91
Answer: A
Conceptual Explanation: Modifier 59 is used to identify procedures/services that are
commonly bundled but are distinct in a specific case. Fraudulent use involves appending it
solely to bypass edits and receive separate payment.
