AHIP FRAUD WASTE AND ABUSE
EXAM NEWEST 2025 ACTUAL
EXAM COMPLETE QUESTIONS
AND 100% CORRECT DETAILED
ANSWERS (VERIFIED ANSWERS)
|ALREADY GRADED A+
Which Medicare programs are covered by ACA
Section 1557? - ....ANSWER...Parts A, C, and D, but not
B.
Under ACA Section 1557, prohibited actions involve -
....ANSWER...eligibility, claims, and marketing.
Under ACA Section 1557, a person -
....ANSWER...cannot be discriminated against based
on her legal or illegal immigration status or ability to
speak English.
Under ACA Section 1557, a health plan -
....ANSWER...cannot deny coverage to LEP individuals
,and is required to provide language assistance to
them, free of charge
Which of these actions is most likely to be permitted
in dealing with a person with limited English
proficiency? - ....ANSWER...Allowing a child to
interpret in an emergency.
Under ACA Section 1557, sex discrimination includes
a person's - ....ANSWER...sex, pregnancy, sex
stereotypes, or gender identity
Under ACA Section 1557, a health plan sold through a
state exchange may, based on an individual's age, -
....ANSWER...charge higher premiums.
ACA Section 1557 rules for disability concern -
....ANSWER...Policies and procedures, physical
access, and communication.
If a health plan violates ACA Section 1557
nondiscrimination protections, it may be -
....ANSWER...required to take corrective action and
sometimes pay damages, and it may be sued by
individuals.
,As a result of violations of ACA Section 1557
nondiscrimination rules, - ....ANSWER...a health plan
may revoke an agent or broker's appointment with
the health plan.
For a health plan, what are the possible
consequences of violations of ACA Section 1557? -
....ANSWER...Loss of federal business and
compensatory damages.
Which area of potential discrimination is not
generally covered by ACA Section 1557? -
....ANSWER...Employment (with the exception of the
provision of health insurance).
Which of the following requires intent to obtain
payment and the knowledge that the actions are
wrong? - ....ANSWER.... Fraud
Which of the following is NOT potentially a penalty
for violation of a law or regulation prohibiting Fraud,
Waste, and Abuse (FWA)? - ....ANSWER...Deportation
, A person comes to 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 prescription and have concerns about
possible forgery. What is your next step? -
....ANSWER...Call the prescriber to verify the quantity
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 verify,
through a certain process, that the data is accurate.
Your immediate supervisor tells you to ignore the
Sponsor's 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)
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 a certain procedure. You review the
same type of procedure for other diagnostic
providers and realize that Doe Diagnostics' claims
EXAM NEWEST 2025 ACTUAL
EXAM COMPLETE QUESTIONS
AND 100% CORRECT DETAILED
ANSWERS (VERIFIED ANSWERS)
|ALREADY GRADED A+
Which Medicare programs are covered by ACA
Section 1557? - ....ANSWER...Parts A, C, and D, but not
B.
Under ACA Section 1557, prohibited actions involve -
....ANSWER...eligibility, claims, and marketing.
Under ACA Section 1557, a person -
....ANSWER...cannot be discriminated against based
on her legal or illegal immigration status or ability to
speak English.
Under ACA Section 1557, a health plan -
....ANSWER...cannot deny coverage to LEP individuals
,and is required to provide language assistance to
them, free of charge
Which of these actions is most likely to be permitted
in dealing with a person with limited English
proficiency? - ....ANSWER...Allowing a child to
interpret in an emergency.
Under ACA Section 1557, sex discrimination includes
a person's - ....ANSWER...sex, pregnancy, sex
stereotypes, or gender identity
Under ACA Section 1557, a health plan sold through a
state exchange may, based on an individual's age, -
....ANSWER...charge higher premiums.
ACA Section 1557 rules for disability concern -
....ANSWER...Policies and procedures, physical
access, and communication.
If a health plan violates ACA Section 1557
nondiscrimination protections, it may be -
....ANSWER...required to take corrective action and
sometimes pay damages, and it may be sued by
individuals.
,As a result of violations of ACA Section 1557
nondiscrimination rules, - ....ANSWER...a health plan
may revoke an agent or broker's appointment with
the health plan.
For a health plan, what are the possible
consequences of violations of ACA Section 1557? -
....ANSWER...Loss of federal business and
compensatory damages.
Which area of potential discrimination is not
generally covered by ACA Section 1557? -
....ANSWER...Employment (with the exception of the
provision of health insurance).
Which of the following requires intent to obtain
payment and the knowledge that the actions are
wrong? - ....ANSWER.... Fraud
Which of the following is NOT potentially a penalty
for violation of a law or regulation prohibiting Fraud,
Waste, and Abuse (FWA)? - ....ANSWER...Deportation
, A person comes to 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 prescription and have concerns about
possible forgery. What is your next step? -
....ANSWER...Call the prescriber to verify the quantity
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 verify,
through a certain process, that the data is accurate.
Your immediate supervisor tells you to ignore the
Sponsor's 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)
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 a certain procedure. You review the
same type of procedure for other diagnostic
providers and realize that Doe Diagnostics' claims
