AHIP other Exam| Questions (Latest Update 2026/2027) With 100%
Correct Answers |Verified
Which of the following requires intent to obtain payment and the knowledge that the actions
are wrong? - ✔️✔️Fraud
Which of the following is NOT potentially a penalty for violation of a law or regulation
prohibiting Fraud, Waste, and Abuse (FWA)? - ✔️✔️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? - ✔️✔️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? - ✔️✔️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 far exceed any other provider
that you reviewed. What should you do? - ✔️✔️Consult with your immediate supervisor for
next steps or contact the compliance department (via compliance hotline, Special Investigations
Unit (SIU), or other mechanism)
You are performing a regular inventory of the controlled substances in the pharmacy. You
discover a minor inventory discrepancy. What should you do? - ✔️✔️Follow your pharmacy's
procedures
Correct Answers |Verified
Which of the following requires intent to obtain payment and the knowledge that the actions
are wrong? - ✔️✔️Fraud
Which of the following is NOT potentially a penalty for violation of a law or regulation
prohibiting Fraud, Waste, and Abuse (FWA)? - ✔️✔️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? - ✔️✔️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? - ✔️✔️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 far exceed any other provider
that you reviewed. What should you do? - ✔️✔️Consult with your immediate supervisor for
next steps or contact the compliance department (via compliance hotline, Special Investigations
Unit (SIU), or other mechanism)
You are performing a regular inventory of the controlled substances in the pharmacy. You
discover a minor inventory discrepancy. What should you do? - ✔️✔️Follow your pharmacy's
procedures
