AHIP 2024 FINAL REVIEW FWA 3
QUESTIONS AND ANSWERS WITH
VERIFIED SOLUTIONS 2024
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 pharmacy's procedures.
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 use a process to verify the data is accurate. Your immediate supervisor tells you to ignore the
Sponsor's process and to adjust or
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)
Which of the following is NOT potentially a penalty for violation of a law or regulation prohibiting fraud,
waste, and abuse (FWA)? - ANSWER Deportation
You are in charge of paying claims submitted by providers. You notice a certain diagnostic provider ("Doe
Diagnostics") requested a
substantial payment for a large patient group. Many of these claims are for a certain procedure. You
review the same type of procedure
for other diagnostic providers and realize Doe Diagnostics' claims far exceed any other provider 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)
A person drops 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
QUESTIONS AND ANSWERS WITH
VERIFIED SOLUTIONS 2024
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 pharmacy's procedures.
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 use a process to verify the data is accurate. Your immediate supervisor tells you to ignore the
Sponsor's process and to adjust or
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)
Which of the following is NOT potentially a penalty for violation of a law or regulation prohibiting fraud,
waste, and abuse (FWA)? - ANSWER Deportation
You are in charge of paying claims submitted by providers. You notice a certain diagnostic provider ("Doe
Diagnostics") requested a
substantial payment for a large patient group. Many of these claims are for a certain procedure. You
review the same type of procedure
for other diagnostic providers and realize Doe Diagnostics' claims far exceed any other provider 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)
A person drops 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
