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AHIP FRAUD, WASTE, & ABUSE FINAL EXAM | 2025-2026
LATEST UPDATED | ACTUAL EXAM QUESTIONS WITH
SOLUTIONS | 100% RATED CORRECT | 100% VERFIED
SOLTIONS | ALREADY GRADED A+
Which of the following requires intent to obtain payment and the knowledge the
actions are wrong? - (answer)Fraud
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
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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.
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
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)
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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. - (answer)True
Some of the laws governing Medicare Part C and D fraud, waste, and abuse (FWA)
include the Health Insurance Portability and Accountability Act (HIPAA), the Civil
False Claims Act, the Anti-Kickback Statute, and the Criminal Health Care Fraud
Statute. - (answer)True
You can help prevent fraud, waste, and abuse (FWA) by doing all the following:
Look for suspicious activity
Conduct yourself in an ethical manner
Ensure accurate and timely data and billing
AHIP FRAUD, WASTE, & ABUSE FINAL EXAM | 2025-2026
LATEST UPDATED | ACTUAL EXAM QUESTIONS WITH
SOLUTIONS | 100% RATED CORRECT | 100% VERFIED
SOLTIONS | ALREADY GRADED A+
Which of the following requires intent to obtain payment and the knowledge the
actions are wrong? - (answer)Fraud
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
,2|Page
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.
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
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)
, 3|Page
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. - (answer)True
Some of the laws governing Medicare Part C and D fraud, waste, and abuse (FWA)
include the Health Insurance Portability and Accountability Act (HIPAA), the Civil
False Claims Act, the Anti-Kickback Statute, and the Criminal Health Care Fraud
Statute. - (answer)True
You can help prevent fraud, waste, and abuse (FWA) by doing all the following:
Look for suspicious activity
Conduct yourself in an ethical manner
Ensure accurate and timely data and billing
