AHFI EXAM QUESTIONS WITH CORRECT ANSWERS GRADED A+ FOR ASSURED EXCEL!!.pdf

AHFI EXAM QUESTIONS WITH
CORRECT ANSWERS GRADED A+
FOR 2026-2027 ASSURED EXCEL!!
Anti-KickbackYStatuteY(42YUSYSSY1320a-7bY(b)YprohibitionsY-
YYCORRECTYANSWERSProhibitsYoffering,Ypaying,YsolicitingYorYrevivingYanythingYofYvalueYtoYinduceYo


rYrewardYreferralsYorYgenerateYFederalYhealthYcareYprogramYbusiness



Anti-KickbackYStatuteY(42YUSYSSY1320a-7bY(b)YreferralsY-
YYCORRECTYANSWERSReferralsYfromYanyone




Anti-KickbackYStatuteY(42YUSYSSY1320a-7bY(b)Y-YYCORRECTYANSWERSAnyYitemsYorYservices



Anti-KickbackYStatuteY(42YUSYSSY1320a-7bY(b)Y(Intent)Y-
YYCORRECTYANSWERSIntentYMUSTYbeYprovenY(knowingYandYwillful)




Anti-KickbackYStatuteY(42YUSYSSY1320a-7bY(b)YCriminalYpenaltiesY-
YYCORRECTYANSWERSFinesYupYtoY$25,000/violation




UpYtoYaY5-yrYprisonYterm/violation



Anti-KickbackYStatuteY(42YUSYSSY1320a-7bY(b)Y(Civil/administrative)Y-
YYCORRECTYANSWERSFalseYClaimsYactYliability




CivilYmonetaryYpenaltiesYandYprogramYexclusions



PotentialY$50,000YCMP/violation

,CivilYassessmentYofYupYtoY3xYamountYofYkickback



Anti-KickbackYStatuteY(42YUSYSSY1320a-7bY(b)YExceptionsY-
YYCORRECTYANSWERSVoluntaryYsafeYharbors




Anti-KickbackYStatuteY(42YUSYSSY1320a-7bY(b)Y-YwhatYitYappliesYto...Y-
YYCORRECTYANSWERSAllYFederalYHealthYCareYPrograms




TheYStarkYLawY(42YUSYSSY139nn)YProhibitionY-
YYCORRECTYANSWERSProhibitsYaYphysicianYfromYreferringYMedicareYpatientsYforYdesignatedYhealth


YservicesYtoYanYentityYwithYwhichYtheYphysicianY(orYimmediateYfamilyYmember)YhasYaYfinancialYrelat


ionship,YunlessYanYexceptionYapplies)Y



ProhibitsYtheYdesignatedYhealthYservicesYentityYfromYsubmittingYclaimsYtoYMedicareYforYthoseYserv
icesYresultingYfromYaYprohibitedYreferral



TheYStarkYLawY(42YUSYSSY139nn)YReferralsY-YYCORRECTYANSWERSReferralsYfromYaYphysician



TheYStarkYLawY(42YUSYSSY139nn)Y(Items/Services)Y-
YYCORRECTYANSWERSDesignatedYhealthYservices




TheYStarkYLawY(42YUSYSSY139nn)Y(Intent)Y-
YYCORRECTYANSWERSNoYintentYstandardYforYoverpaymentY(strictYliability)Y




IntentYrequiredYforYcivilYmonetaryYpenaltiesYforYknowingYviolations



TheYStarkYLawY(42YUSYSSY139nn)Y(CivilYPenalties)YonlyY-
YYCORRECTYANSWERSOverpayment/refund Yobligation

, FalseYClaimsYActYliability



CivilYmonetaryYpenaltiesYandYprogramYexclusionYforYknowingYviolations



PotentialY$15,000YCMPYforYeachYservice



CivilYassessmentYofYupYtoY3xYtheYamountYclaimed.



TheYStarkYLawY(42YUSYSSY139nn)Y(Exceptions)Y-YYCORRECTYANSWERSMandatoryYexceptions



TheYStarkYLawY(42YUSYSSY139nn)YappliesYtoY-YYCORRECTYANSWERSMedicareYandYMedicaidY



(NoYcommercialYorYtricare)



MACs:Y-YYCORRECTYANSWERSMedicareYAdministrativeYContractors



TheyYanalyzeYclaimsYtoYdetermineYproviderYcomplianceYwithYMedicareYcoverage,Ycoding,YandYbilli
ngYrulesYandYtakeYappropriateYcorrectiveYactionYwhenYprovidersYareYfoundYtoYbeYnon-compliant.



TheYgoalYofYMacYadministrativeYactionsY-
YYCORRECTYANSWERSToYcorrectYtheYbehaviorYinYneedYofYchangeYandYpreventYfutureYinappropriateY


billing



TheYpriorityYofYMACsY-
YYCORRECTYANSWERSToYminimizeYpotentialYfutureYlossesYtoYtheYMedicareYTrustYFundYthroughYtarg


etedYclaimsYreviewYwhileYusingYresourceYefficientlyYandYtreatingYprovidersYandYbeneficiariesYfairly.