AHIP - Discrimination, Fraud, Waste, & Abuse – 2026 | Real Exam Questions with Correct Answers, A+ Score Solutions.

AHIP - Discrimination, Fraud, Waste, & Abuse – 2026 | Real Exam Questions with Correct Answers, A+ Score Solutions. Quiz_________________? 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 Quiz_________________? A sales agent, employed by the Sponsor's first-tier, downstream, or related entity (FDR), submitted an application for processing and requested two things: 1) to back-date the enrollment date by one month, and 2) to waive all monthly premiums for the beneficiary. What should you do? - Answer Process the application properly (without the requested revisions)—inform your supervisor and the compliance officer about the sales agent's request Quiz_________________? Abuse involves payment for items or services when there is no legal entitlement to that payment and the provider has not knowingly or intentionally misrepresented facts to obtain payment. - Answer True Quiz_________________? ACA Section 1557 rules for disability concern - Answer policies and procedures, physical access, and communication. Quiz_________________? 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. - Answer False Quiz_________________? 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. Quiz_________________? At a minimum, an effective compliance program includes four core requirements. - Answer False Quiz_________________? Auxiliary aids and services must be provided to individuals with disabilities, such as those suffering from vision or hearing impairments, free of charge, and in a timely manner. Auxiliary aids and services include which of the following: I. large print materials II. qualified sign language interpreters III. braille materials and displays IV. screen reader software - Answer I, II, III, and IV Quiz_________________? 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 Quiz_________________? Compliance is the responsibility of the Compliance Officer, Compliance Committee, and Upper Management only. - Answer False Quiz_________________? Correcting non-compliance________. - Answer Protects enrollees, avoids recurrence of same non-compliance, and promotes efficiency Quiz_________________? For a health plan, what are the possible consequences of violations of ACA Section 1557? - Answer Loss of federal business and compensatory damages. Quiz_________________? Medicare Parts C and D sponsors are not required to have a compliance program. - Answer False