Ahip fraud waste & abuse 2024/2025 Questions and Answers with complete solution

Ahip fraud waste & abuse 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 pr escription and have concerns about the possible forgery. What is your next step? - Answer -Call the prescriber to verify the quantity Which of the following is not potentially a penalty for violation of the law or regulation prohibiting fraud, waste and abuse (fwa)? - Answer -Deportation Which of the following requires intent to obtain payment and the knowledge that the actions are wrong? - Answer -Fraud 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 certain procedure. You review the same t ype of procedure for other diagnostic providers and realize that doe diagnostics' claim far exceed any other provider that you reviewed. What should you do? - Answer -Consult with your immediate supervisor for the next steps or contact the compliance depart ment (via compliance hotline, special investigation unit (siu), or other mechanism) You are performing a regular inventory of the controlled substances in the pharmacy. You discover a minor inventory discrepancy. What should you do? - Answer -Follow your pharmacys procedures 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 s ponsors 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)