AHIP COMPREHENSIVE STUDY GUIDE WITH COMPLETE SOLVED
QUESTIONS AND VERIFIED ANSWERS | UPDATED ACTUAL Exam
Questions and CORRECT Answers
Question 1.
Which of the following requires intent to obtain payment and the knowledge that the
actions are wrong?
Answer: Fraud
Question 2.
Which of the following is NOT potentially a penalty for violation of a law or regulation
prohibiting Fraud, Waste, and Abuse (FWA)?
Answer: Deportation
Question 3.
A person comes to 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 possible forgery. What is your next step?
Answer: Call the prescriber to verify the quantity
Question 4.
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 verify, through a certain
process, that the data is accurate. 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?
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 substantial
payment for a large number of members. Many of these claims are for a
certain procedure. You review the same type of procedure for other diagnostic
providers and realize that Doe Diagnostics' claims far exceed any other
provider that you reviewed. What should you do? Answer: Consult with your
immediate supervisor for next steps or contact the compliance department
(via compliance hotline, Special Investigations Unit (SIU), or other mechanism)
Question 5.
You are performing a regular inventory of the controlled substances in the pharmacy.
You discover a minor inventory discrepancy. What should you do?
QUESTIONS AND VERIFIED ANSWERS | UPDATED ACTUAL Exam
Questions and CORRECT Answers
Question 1.
Which of the following requires intent to obtain payment and the knowledge that the
actions are wrong?
Answer: Fraud
Question 2.
Which of the following is NOT potentially a penalty for violation of a law or regulation
prohibiting Fraud, Waste, and Abuse (FWA)?
Answer: Deportation
Question 3.
A person comes to 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 possible forgery. What is your next step?
Answer: Call the prescriber to verify the quantity
Question 4.
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 verify, through a certain
process, that the data is accurate. 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?
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 substantial
payment for a large number of members. Many of these claims are for a
certain procedure. You review the same type of procedure for other diagnostic
providers and realize that Doe Diagnostics' claims far exceed any other
provider that you reviewed. What should you do? Answer: Consult with your
immediate supervisor for next steps or contact the compliance department
(via compliance hotline, Special Investigations Unit (SIU), or other mechanism)
Question 5.
You are performing a regular inventory of the controlled substances in the pharmacy.
You discover a minor inventory discrepancy. What should you do?
