AHIP 2025 Final Review FWA 3 Questions & Answers.
1. You are performing a regular inventory of the
con- trolled substances in the pharmacy. You Follow your pharmacy's
discover a minor inventory discrepancy. proce- dures.
What should you do?
2. Your job is to submit a risk diagnosis to the Centers Report the incident to the
com-
for Medicare & Medicaid Services (CMS) for the pur- pliance department (via
compli-
pose of payment. As part of this ance hotline or other
mecha-
job, you use a process to verify the data is accurate.
nism) 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?
3. Which of the following is NOT potentially a Deportation
penal- ty for violation of a law or regulation
prohibiting fraud, waste, and abuse (FWA)?
4. You are in charge of paying claims submitted
by providers. You notice a certain diagnostic Consult with your immediate
provider ("Doe Diagnostics") requested a
substantial payment for a large patient su- pervisor for next steps or
group. Many of these claims are for a certain contact the compliance
procedure. department (via
You review the same type of procedure compliance hotline,
for other diagnostic providers and realize Doe Special Investigations
Di- agnostics' claims far exceed any other
provider you reviewed. What should you do? Unit [SIU], or other
mechanism)
5. 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 Call the prescriber to verify
the quantity
1/
2
1. You are performing a regular inventory of the
con- trolled substances in the pharmacy. You Follow your pharmacy's
discover a minor inventory discrepancy. proce- dures.
What should you do?
2. Your job is to submit a risk diagnosis to the Centers Report the incident to the
com-
for Medicare & Medicaid Services (CMS) for the pur- pliance department (via
compli-
pose of payment. As part of this ance hotline or other
mecha-
job, you use a process to verify the data is accurate.
nism) 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?
3. Which of the following is NOT potentially a Deportation
penal- ty for violation of a law or regulation
prohibiting fraud, waste, and abuse (FWA)?
4. You are in charge of paying claims submitted
by providers. You notice a certain diagnostic Consult with your immediate
provider ("Doe Diagnostics") requested a
substantial payment for a large patient su- pervisor for next steps or
group. Many of these claims are for a certain contact the compliance
procedure. department (via
You review the same type of procedure compliance hotline,
for other diagnostic providers and realize Doe Special Investigations
Di- agnostics' claims far exceed any other
provider you reviewed. What should you do? Unit [SIU], or other
mechanism)
5. 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 Call the prescriber to verify
the quantity
1/
2
