AHIP FRAUD WASTE AND ABUSE EXAM
AHIP FRAUD WASTE AND ABUSE
EXAM STUDY QUESTIONS WITH
CORRECT DETAILED ANSWERS
GRADED A 2025
e -Correct Answer ✔Ways to report potential Fraud, Waste, and Abuse (FWA) include:
a. Telephone hotlines
b. Mail Drops
c. In-person reporting to the compliance department/supervisor
d. Special Investigations Units (SIUs)
e. All of the above
false -Correct Answer ✔Once a corrective action plan is started, the corrective actions
must be monitored annually to ensure they are effective.
:
True False
false -Correct Answer ✔Any person who knowingly submits false claims to the
Government is liable for five times the Government's damages caused by the violator
plus a penalty.
:
True False
true -Correct Answer ✔These are examples of issues that should be reported to a
Compliance Department: suspected Fraud, Waste, and Abuse (FWA); potential health
privacy violation, and unethical behavior/employee misconduct.
:
True False
true -Correct Answer ✔Bribes or kickbacks of any kind for services that are paid under a
Federal health care program (which includes Medicare) constitute fraud by the person
making as well as the person receiving them.
:
AHIP FRAUD WASTE AND ABUSE EXAM
, AHIP FRAUD WASTE AND ABUSE EXAM
True False
true -Correct Answer ✔Waste includes any misuse of resources such as the overuse of
services, or other practices that, directly or indirectly, result in unnecessary costs to the
Medicare Program.
:
True False
ACA Section 1557 differs from earlier legislation in providing broader protection against
discrimination based on -Correct Answer ✔sex
Section 1557 of the Affordable Care Act applies to -Correct Answer ✔c. all health
programs and activities administered by or receiving federal financial assistance from
HHS. Correct
Which Medicare programs are covered by ACA Section 1557? -Correct Answer ✔a.
Parts A, C, and D, but not B. Correct
Under ACA Section 1557, prohibited actions involve -Correct Answer ✔d. eligibility,
claims, and marketing. Correct
Under ACA Section 1557, a person -Correct Answer ✔c. cannot be discriminated
against based on her legal or illegal immigration status or ability to speak English.
Correct
Under ACA Section 1557, a health plan -Correct Answer ✔d. cannot deny coverage to
LEP individuals and is required to provide language assistance to them, free of charge.
Correct
Which of these actions is most likely to be permitted in dealing with a person with limited
English proficiency? -Correct Answer ✔a. Allowing a child to interpret in an emergency.
Correct
Under ACA Section 1557, sex discrimination includes a person's -Correct Answer ✔c.
sex, pregnancy, sex stereotypes, or gender identity. Correct
Under ACA Section 1557, a health plan sold through a state exchange may, based on
an individual's age, -Correct Answer ✔d. charge higher premiums. Correct
ACA Section 1557 rules for disability concern -Correct Answer ✔d. Policies and
procedures, physical access, and communication. Correct
AHIP FRAUD WASTE AND ABUSE EXAM
AHIP FRAUD WASTE AND ABUSE
EXAM STUDY QUESTIONS WITH
CORRECT DETAILED ANSWERS
GRADED A 2025
e -Correct Answer ✔Ways to report potential Fraud, Waste, and Abuse (FWA) include:
a. Telephone hotlines
b. Mail Drops
c. In-person reporting to the compliance department/supervisor
d. Special Investigations Units (SIUs)
e. All of the above
false -Correct Answer ✔Once a corrective action plan is started, the corrective actions
must be monitored annually to ensure they are effective.
:
True False
false -Correct Answer ✔Any person who knowingly submits false claims to the
Government is liable for five times the Government's damages caused by the violator
plus a penalty.
:
True False
true -Correct Answer ✔These are examples of issues that should be reported to a
Compliance Department: suspected Fraud, Waste, and Abuse (FWA); potential health
privacy violation, and unethical behavior/employee misconduct.
:
True False
true -Correct Answer ✔Bribes or kickbacks of any kind for services that are paid under a
Federal health care program (which includes Medicare) constitute fraud by the person
making as well as the person receiving them.
:
AHIP FRAUD WASTE AND ABUSE EXAM
, AHIP FRAUD WASTE AND ABUSE EXAM
True False
true -Correct Answer ✔Waste includes any misuse of resources such as the overuse of
services, or other practices that, directly or indirectly, result in unnecessary costs to the
Medicare Program.
:
True False
ACA Section 1557 differs from earlier legislation in providing broader protection against
discrimination based on -Correct Answer ✔sex
Section 1557 of the Affordable Care Act applies to -Correct Answer ✔c. all health
programs and activities administered by or receiving federal financial assistance from
HHS. Correct
Which Medicare programs are covered by ACA Section 1557? -Correct Answer ✔a.
Parts A, C, and D, but not B. Correct
Under ACA Section 1557, prohibited actions involve -Correct Answer ✔d. eligibility,
claims, and marketing. Correct
Under ACA Section 1557, a person -Correct Answer ✔c. cannot be discriminated
against based on her legal or illegal immigration status or ability to speak English.
Correct
Under ACA Section 1557, a health plan -Correct Answer ✔d. cannot deny coverage to
LEP individuals and is required to provide language assistance to them, free of charge.
Correct
Which of these actions is most likely to be permitted in dealing with a person with limited
English proficiency? -Correct Answer ✔a. Allowing a child to interpret in an emergency.
Correct
Under ACA Section 1557, sex discrimination includes a person's -Correct Answer ✔c.
sex, pregnancy, sex stereotypes, or gender identity. Correct
Under ACA Section 1557, a health plan sold through a state exchange may, based on
an individual's age, -Correct Answer ✔d. charge higher premiums. Correct
ACA Section 1557 rules for disability concern -Correct Answer ✔d. Policies and
procedures, physical access, and communication. Correct
AHIP FRAUD WASTE AND ABUSE EXAM
