AHIP FWA EXAM PAPER UPDATED ACTUAL
QUESTIONS AND CORRECT ANSWERS
◉ Which of the following is not potentially a penalty for violation of the
law or regulation prohibiting fraud, waste and abuse (fwa)? Answer:
Deportation
◉ A person comes into your pharmacy to drop 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 the possible forgery. What is your next step? Answer:
Call the prescriber to verify the quantity
◉ Your job is to submit risk diagnosis to the centers for Medicare &
medicaid services (cms) for the purpose of payment. As part of this job
you verify, through a certain process, that the data is accurate. Your
immediate supervisor tells you to ignore the sponsors process and to
adjust/add risk diagnosis codes for certain individuals. What should you
do? Answer: Report the incident to the compliance department (via
compliance hotline or other mechanism)
◉ You are in charge of payment of claims submitted by providers. You
notice a certain diagnostic provider ("doe diagnostics") requested a
QUESTIONS AND CORRECT ANSWERS
◉ Which of the following is not potentially a penalty for violation of the
law or regulation prohibiting fraud, waste and abuse (fwa)? Answer:
Deportation
◉ A person comes into your pharmacy to drop 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 the possible forgery. What is your next step? Answer:
Call the prescriber to verify the quantity
◉ Your job is to submit risk diagnosis to the centers for Medicare &
medicaid services (cms) for the purpose of payment. As part of this job
you verify, through a certain process, that the data is accurate. Your
immediate supervisor tells you to ignore the sponsors process and to
adjust/add risk diagnosis codes for certain individuals. What should you
do? Answer: Report the incident to the compliance department (via
compliance hotline or other mechanism)
◉ You are in charge of payment of claims submitted by providers. You
notice a certain diagnostic provider ("doe diagnostics") requested a
