2026 AHIP FWA Module – Discrimination, Fraud,
Waste & Abuse Exam
,1.
Which statement best describes fraud in a Medicare context?
A. An accidental billing error
B. Intentional deception or misrepresentation made to obtain an
unauthorized benefit
C. A legitimate difference in medical opinion
D. A delayed claim submission
Fraud involves intentional deception or misrepresentation for an
improper benefit.
2.
What is waste?
A. Deliberate falsification of records
B. Identity theft
C. Overuse or misuse of services that results in unnecessary costs
D. A beneficiary changing plans
Waste generally involves unnecessary or inefficient use of resources
without necessarily involving intentional deception.
3.
Abuse generally refers to:
A. Intentional criminal conduct only
B. Practices that are inconsistent with accepted standards and may
result in unnecessary costs
C. Any rejected claim
D. Any provider complaint
Abuse can involve practices that improperly increase costs or fail to
meet recognized standards, even when intentional deception is not
established.
4.
,Which activity is an example of potential fraud?
A. Correcting a coding mistake
B. Billing Medicare for services that were never provided
C. Reviewing a claim before submission
D. Updating a beneficiary's address
Billing for services that were never delivered is a classic example of
fraudulent billing.
5.
Why are FWA controls important?
A. They eliminate all Medicare claims
B. They increase premiums automatically
C. They help protect Medicare resources and beneficiaries
D. They prevent beneficiaries from receiving services
FWA controls help preserve program funds and protect beneficiaries
from inappropriate practices.
6.
A provider knowingly submits claims for a higher level of service than
was actually provided. This may constitute:
A. Education
B. Waste only
C. Fraud
D. Enrollment
Knowingly misrepresenting services to obtain greater payment can
constitute fraud.
7.
What should an employee do after identifying a potentially
fraudulent activity?
, A. Ignore it
B. Discuss it publicly on social media
C. Report it through the appropriate compliance or reporting
channel
D. Alter the records
Potential FWA should be reported through established organizational
channels.
8.
Which is an example of waste?
A. Creating a false patient
B. Ordering unnecessary duplicate services because records were
not reviewed
C. Intentionally falsifying a claim
D. Stealing a beneficiary's identity
Unnecessary services caused by inefficient processes can represent
waste.
9.
Which situation is most clearly abuse?
A. Correctly billing for a service
B. Repeatedly using inappropriate billing practices that result in
unnecessary costs
C. Reporting suspected fraud
D. Updating provider credentials
Abusive practices may improperly increase costs without necessarily
meeting the definition of intentional fraud.
10.
What is the primary purpose of a compliance program?
Waste & Abuse Exam
,1.
Which statement best describes fraud in a Medicare context?
A. An accidental billing error
B. Intentional deception or misrepresentation made to obtain an
unauthorized benefit
C. A legitimate difference in medical opinion
D. A delayed claim submission
Fraud involves intentional deception or misrepresentation for an
improper benefit.
2.
What is waste?
A. Deliberate falsification of records
B. Identity theft
C. Overuse or misuse of services that results in unnecessary costs
D. A beneficiary changing plans
Waste generally involves unnecessary or inefficient use of resources
without necessarily involving intentional deception.
3.
Abuse generally refers to:
A. Intentional criminal conduct only
B. Practices that are inconsistent with accepted standards and may
result in unnecessary costs
C. Any rejected claim
D. Any provider complaint
Abuse can involve practices that improperly increase costs or fail to
meet recognized standards, even when intentional deception is not
established.
4.
,Which activity is an example of potential fraud?
A. Correcting a coding mistake
B. Billing Medicare for services that were never provided
C. Reviewing a claim before submission
D. Updating a beneficiary's address
Billing for services that were never delivered is a classic example of
fraudulent billing.
5.
Why are FWA controls important?
A. They eliminate all Medicare claims
B. They increase premiums automatically
C. They help protect Medicare resources and beneficiaries
D. They prevent beneficiaries from receiving services
FWA controls help preserve program funds and protect beneficiaries
from inappropriate practices.
6.
A provider knowingly submits claims for a higher level of service than
was actually provided. This may constitute:
A. Education
B. Waste only
C. Fraud
D. Enrollment
Knowingly misrepresenting services to obtain greater payment can
constitute fraud.
7.
What should an employee do after identifying a potentially
fraudulent activity?
, A. Ignore it
B. Discuss it publicly on social media
C. Report it through the appropriate compliance or reporting
channel
D. Alter the records
Potential FWA should be reported through established organizational
channels.
8.
Which is an example of waste?
A. Creating a false patient
B. Ordering unnecessary duplicate services because records were
not reviewed
C. Intentionally falsifying a claim
D. Stealing a beneficiary's identity
Unnecessary services caused by inefficient processes can represent
waste.
9.
Which situation is most clearly abuse?
A. Correctly billing for a service
B. Repeatedly using inappropriate billing practices that result in
unnecessary costs
C. Reporting suspected fraud
D. Updating provider credentials
Abusive practices may improperly increase costs without necessarily
meeting the definition of intentional fraud.
10.
What is the primary purpose of a compliance program?
