AHIP Certification Exam 2027 | Actual Q&A (AHIP
Certification Exam 2027) (50 Questions)
Fraud, Waste, Abuse Detection, Compliance, Legal Obligations
Instructions: Select the best answer for each compliance-driven scenario.
Answer Key
| # | Answer | # | Answer | # | Answer | # | Answer | # | Answer |
|---|--------|---|--------|---|--------|---|--------|---|--------|
| 1 | C | 11 | A | 21 | A | 31 | A | 41 | A |
| 2 | B | 12 | D | 22 | B | 32 | A | 42 | A |
| 3 | A | 13 | A | 23 | A | 33 | A | 43 | A |
| 4 | A | 14 | A | 24 | B | 34 | A | 44 | A |
| 5 | A | 15 | A | 25 | A | 35 | A | 45 | C |
| 6 | B | 16 | A | 26 | A | 36 | D | 46 | A |
| 7 | A | 17 | A | 27 | A | 37 | A | 47 | A |
| 8 | B | 18 | A | 28 | A | 38 | B | 48 | A |
| 9 | A | 19 | B | 29 | A | 39 | A | 49 | D |
| 10 | A | 20 | A | 30 | A | 40 | A | 50 | A |
1. A provider bills Medicare for services that were never provided. This is an example of:
A) Waste
B) Abuse
C) Fraud
D) An administrative error
2. A physician routinely bills for a higher level of evaluation than the service actually
performed. This is considered:
A) Fraud
B) Abuse
C) Acceptable billing practice
D) A coding error with no penalty
3. Which of the following is an example of a kickback scheme?
, A) A provider pays a patient's Medicare deductible as an incentive to use their services.
B) A provider bills for a covered service.
C) A provider submits a claim with a minor typo.
D) A provider offers a discount for cash payments.
4. The federal Anti-Kickback Statute prohibits:
A) Offering, paying, soliciting, or receiving remuneration to induce referrals of Medicare
business.
B) Billing for services that are not covered by Medicare.
C) Using the Medicare logo without permission.
D) Providing preventive services at no cost to beneficiaries.
5. The False Claims Act allows:
A) Whistleblowers to file lawsuits on behalf of the government for fraud.
B) Providers to submit corrected claims without penalty.
C) Beneficiaries to appeal denied claims.
D) Agents to market plans without CMS approval.
6. A Medicare beneficiary receives a free television in exchange for enrolling in a
Medicare Advantage plan. This is:
A) A lawful marketing incentive.
B) A violation of the Anti-Kickback Statute and CMS marketing rules.
C) Permissible if the television is valued at $15 or less.
D) Allowed if the beneficiary requests it.
7. A sales agent knowingly enrolls a beneficiary in a Medicare Advantage plan that does
not meet the beneficiary's needs. This is:
A) Fraud
B) Abuse
C) Waste
D) A permissible sales practice
Certification Exam 2027) (50 Questions)
Fraud, Waste, Abuse Detection, Compliance, Legal Obligations
Instructions: Select the best answer for each compliance-driven scenario.
Answer Key
| # | Answer | # | Answer | # | Answer | # | Answer | # | Answer |
|---|--------|---|--------|---|--------|---|--------|---|--------|
| 1 | C | 11 | A | 21 | A | 31 | A | 41 | A |
| 2 | B | 12 | D | 22 | B | 32 | A | 42 | A |
| 3 | A | 13 | A | 23 | A | 33 | A | 43 | A |
| 4 | A | 14 | A | 24 | B | 34 | A | 44 | A |
| 5 | A | 15 | A | 25 | A | 35 | A | 45 | C |
| 6 | B | 16 | A | 26 | A | 36 | D | 46 | A |
| 7 | A | 17 | A | 27 | A | 37 | A | 47 | A |
| 8 | B | 18 | A | 28 | A | 38 | B | 48 | A |
| 9 | A | 19 | B | 29 | A | 39 | A | 49 | D |
| 10 | A | 20 | A | 30 | A | 40 | A | 50 | A |
1. A provider bills Medicare for services that were never provided. This is an example of:
A) Waste
B) Abuse
C) Fraud
D) An administrative error
2. A physician routinely bills for a higher level of evaluation than the service actually
performed. This is considered:
A) Fraud
B) Abuse
C) Acceptable billing practice
D) A coding error with no penalty
3. Which of the following is an example of a kickback scheme?
, A) A provider pays a patient's Medicare deductible as an incentive to use their services.
B) A provider bills for a covered service.
C) A provider submits a claim with a minor typo.
D) A provider offers a discount for cash payments.
4. The federal Anti-Kickback Statute prohibits:
A) Offering, paying, soliciting, or receiving remuneration to induce referrals of Medicare
business.
B) Billing for services that are not covered by Medicare.
C) Using the Medicare logo without permission.
D) Providing preventive services at no cost to beneficiaries.
5. The False Claims Act allows:
A) Whistleblowers to file lawsuits on behalf of the government for fraud.
B) Providers to submit corrected claims without penalty.
C) Beneficiaries to appeal denied claims.
D) Agents to market plans without CMS approval.
6. A Medicare beneficiary receives a free television in exchange for enrolling in a
Medicare Advantage plan. This is:
A) A lawful marketing incentive.
B) A violation of the Anti-Kickback Statute and CMS marketing rules.
C) Permissible if the television is valued at $15 or less.
D) Allowed if the beneficiary requests it.
7. A sales agent knowingly enrolls a beneficiary in a Medicare Advantage plan that does
not meet the beneficiary's needs. This is:
A) Fraud
B) Abuse
C) Waste
D) A permissible sales practice
