AHIP 2026 MEDICARE FRAUD WASTE &
ABUSE FINAL PRACTICE 250
QUESTIONS |ORIGINAL QUESTIONS &
ANSWERS |DETAILED RATIONALES
|HINTED COMPLETE EXAM PREP
GRADED
A+*INSTANT DOWNLOAD PDF
1.
Which statement best describes Medicare fraud?
A. An accidental billing error
B. An intentional act of deception to obtain an unauthorized
benefit
C. A necessary utilization-management decision
D. A routine administrative delay
Rationale: Fraud involves intentional deception or misrepresentation
for an unauthorized benefit.
2.
Which term describes an act that is inconsistent with accepted
business or medical practices and results in unnecessary costs?
A. Fraud
B. Abuse
,C. Eligibility
D. Coordination
Rationale: Abuse generally involves practices that are improper or
inconsistent with accepted standards and may result in unnecessary
costs.
3.
Which term generally refers to unnecessary utilization, overuse, or
inefficient practices that result in unnecessary costs without
necessarily involving intentional deception?
A. Fraud
B. Waste
C. Credentialing
D. Adjudication
Rationale: Waste involves inefficient or unnecessary use of resources.
4.
Which of the following is an example of fraud?
A. Correcting a typographical error
B. Asking a compliance question
C. Knowingly submitting a claim for a service that was never
provided
D. Reviewing a claim before payment
Rationale: Knowingly billing Medicare for services not provided is
intentional misrepresentation.
5.
Which is most likely an example of waste?
A. Creating a false medical record
B. Ordering unnecessary supplies because of inefficient practices
,C. Accepting a bribe
D. Falsifying a beneficiary's signature
Rationale: Waste can result from inefficient or unnecessary resource
utilization without requiring deliberate deception.
6.
Which is an example of abuse?
A. Billing for services never rendered with knowledge they were not
provided
B. Providing services that are medically unnecessary because of
poor practices
C. Reporting suspected misconduct
D. Maintaining accurate records
Rationale: Abuse can involve practices that unnecessarily increase
costs or fail to follow accepted standards.
7.
Why is preventing FWA important to Medicare?
A. It eliminates all healthcare costs.
B. It helps protect Medicare resources and beneficiaries.
C. It prevents beneficiaries from receiving services.
D. It eliminates all provider audits.
Rationale: Program-integrity activities are intended to protect
Medicare resources and beneficiaries.
8.
Who may potentially engage in Medicare FWA?
A. Only physicians
B. Only beneficiaries
C. Only insurance companies
D. Any person or entity involved in the Medicare program
, Rationale: FWA risks can arise among beneficiaries, providers,
suppliers, plans, employees, contractors, and other participants.
9.
What is the primary purpose of a Medicare compliance program?
A. Increase premiums
B. Reduce beneficiary enrollment
C. Promote compliance and identify and address potential
violations
D. Eliminate medical necessity reviews
Rationale: Compliance programs establish processes for preventing,
detecting, reporting, and correcting noncompliance.
10.
Which federal agency administers Medicare?
A. FDA
B. OSHA
C. Centers for Medicare & Medicaid Services (CMS)
D. SEC
Rationale: CMS administers Medicare and oversees Medicare
Advantage and Part D organizations.
11.
What does FWA stand for?
A. Federal Wellness Administration
B. Fraud, Waste, and Abuse
C. Financial Wellness Assessment
D. Federal Waiver Authorization
Rationale: FWA is the standard abbreviation for Fraud, Waste, and
Abuse.
12.
ABUSE FINAL PRACTICE 250
QUESTIONS |ORIGINAL QUESTIONS &
ANSWERS |DETAILED RATIONALES
|HINTED COMPLETE EXAM PREP
GRADED
A+*INSTANT DOWNLOAD PDF
1.
Which statement best describes Medicare fraud?
A. An accidental billing error
B. An intentional act of deception to obtain an unauthorized
benefit
C. A necessary utilization-management decision
D. A routine administrative delay
Rationale: Fraud involves intentional deception or misrepresentation
for an unauthorized benefit.
2.
Which term describes an act that is inconsistent with accepted
business or medical practices and results in unnecessary costs?
A. Fraud
B. Abuse
,C. Eligibility
D. Coordination
Rationale: Abuse generally involves practices that are improper or
inconsistent with accepted standards and may result in unnecessary
costs.
3.
Which term generally refers to unnecessary utilization, overuse, or
inefficient practices that result in unnecessary costs without
necessarily involving intentional deception?
A. Fraud
B. Waste
C. Credentialing
D. Adjudication
Rationale: Waste involves inefficient or unnecessary use of resources.
4.
Which of the following is an example of fraud?
A. Correcting a typographical error
B. Asking a compliance question
C. Knowingly submitting a claim for a service that was never
provided
D. Reviewing a claim before payment
Rationale: Knowingly billing Medicare for services not provided is
intentional misrepresentation.
5.
Which is most likely an example of waste?
A. Creating a false medical record
B. Ordering unnecessary supplies because of inefficient practices
,C. Accepting a bribe
D. Falsifying a beneficiary's signature
Rationale: Waste can result from inefficient or unnecessary resource
utilization without requiring deliberate deception.
6.
Which is an example of abuse?
A. Billing for services never rendered with knowledge they were not
provided
B. Providing services that are medically unnecessary because of
poor practices
C. Reporting suspected misconduct
D. Maintaining accurate records
Rationale: Abuse can involve practices that unnecessarily increase
costs or fail to follow accepted standards.
7.
Why is preventing FWA important to Medicare?
A. It eliminates all healthcare costs.
B. It helps protect Medicare resources and beneficiaries.
C. It prevents beneficiaries from receiving services.
D. It eliminates all provider audits.
Rationale: Program-integrity activities are intended to protect
Medicare resources and beneficiaries.
8.
Who may potentially engage in Medicare FWA?
A. Only physicians
B. Only beneficiaries
C. Only insurance companies
D. Any person or entity involved in the Medicare program
, Rationale: FWA risks can arise among beneficiaries, providers,
suppliers, plans, employees, contractors, and other participants.
9.
What is the primary purpose of a Medicare compliance program?
A. Increase premiums
B. Reduce beneficiary enrollment
C. Promote compliance and identify and address potential
violations
D. Eliminate medical necessity reviews
Rationale: Compliance programs establish processes for preventing,
detecting, reporting, and correcting noncompliance.
10.
Which federal agency administers Medicare?
A. FDA
B. OSHA
C. Centers for Medicare & Medicaid Services (CMS)
D. SEC
Rationale: CMS administers Medicare and oversees Medicare
Advantage and Part D organizations.
11.
What does FWA stand for?
A. Federal Wellness Administration
B. Fraud, Waste, and Abuse
C. Financial Wellness Assessment
D. Federal Waiver Authorization
Rationale: FWA is the standard abbreviation for Fraud, Waste, and
Abuse.
12.
