AHFI (ACCREDITED HEALTH CARE
FRAUD INVESTIGATOR) EXAM PREP
2026/27 COMPLETE QUESTIONS AND
VERIFIED SOLUTIONS LATEST
UPDATE
1. Under the False Claims Act (FCA), the ‘knowing’ requirement for liability is met if the
person has:
A. Actual knowledge only
B. Negligent oversight of billing procedures
C. Specific intent to defraud the government
D. Deliberate ignorance or reckless disregard of the truth
Answer: D
Conceptual Explanation: The FCA defines ‘knowing’ to include actual knowledge,
deliberate ignorance, or reckless disregard. It specifically states that no proof of specific
intent to defraud is required.
2. Which of the following describes the practice of ‘unbundling’ in medical coding?
A. Billing for a higher level of service than actually provided
B. Billing for services that were never rendered
,C. Performing unnecessary medical tests to increase revenue
D. Separating components of a procedure and billing each as a separate code to increase
reimbursement
Answer: D
Conceptual Explanation: Unbundling involves reporting multiple codes for components of
a procedure when a single comprehensive code exists, often resulting in higher payments.
3. The Anti-Kickback Statute (AKS) is a criminal law that prohibits the exchange of anything of
value to induce referrals for services payable by:
A. Federal health care programs only
B. Any private insurance company
C. Cash-paying patients only
D. International medical tourism entities
Answer: A
Conceptual Explanation: The AKS specifically applies to services or items that are
reimbursable by Federal health care programs, such as Medicare and Medicaid.
4. What is the primary difference between the Stark Law and the Anti-Kickback Statute?
A. Stark Law is a criminal statute; AKS is strictly civil
B. Stark Law applies to any referral; AKS only applies to physician referrals
C. Stark Law is a strict liability statute; AKS requires proof of intent
, D. There is no functional difference between the two
Answer: C
Conceptual Explanation: Stark Law (Physician Self-Referral Law) is a strict liability
statute, meaning intent does not matter. AKS requires proof of ‘knowing and willful’ intent.
5. A ‘Qui Tam’ action is brought by a private individual, known as a ‘relator’, on behalf of:
A. A private medical practice
B. The American Medical Association
C. The Government
D. The Patient Protection and Affordable Care Act council
Answer: C
Conceptual Explanation: Qui Tam provisions of the False Claims Act allow whistleblowers
(relators) to sue on behalf of the government for fraud and share in the recovery.
6. Which OIG document identifies the specific areas of concern for health care fraud in a given
year?
A. The Monthly Report
B. The Exclusion List
C. The Annual Work Plan
D. The Corporate Integrity Agreement
FRAUD INVESTIGATOR) EXAM PREP
2026/27 COMPLETE QUESTIONS AND
VERIFIED SOLUTIONS LATEST
UPDATE
1. Under the False Claims Act (FCA), the ‘knowing’ requirement for liability is met if the
person has:
A. Actual knowledge only
B. Negligent oversight of billing procedures
C. Specific intent to defraud the government
D. Deliberate ignorance or reckless disregard of the truth
Answer: D
Conceptual Explanation: The FCA defines ‘knowing’ to include actual knowledge,
deliberate ignorance, or reckless disregard. It specifically states that no proof of specific
intent to defraud is required.
2. Which of the following describes the practice of ‘unbundling’ in medical coding?
A. Billing for a higher level of service than actually provided
B. Billing for services that were never rendered
,C. Performing unnecessary medical tests to increase revenue
D. Separating components of a procedure and billing each as a separate code to increase
reimbursement
Answer: D
Conceptual Explanation: Unbundling involves reporting multiple codes for components of
a procedure when a single comprehensive code exists, often resulting in higher payments.
3. The Anti-Kickback Statute (AKS) is a criminal law that prohibits the exchange of anything of
value to induce referrals for services payable by:
A. Federal health care programs only
B. Any private insurance company
C. Cash-paying patients only
D. International medical tourism entities
Answer: A
Conceptual Explanation: The AKS specifically applies to services or items that are
reimbursable by Federal health care programs, such as Medicare and Medicaid.
4. What is the primary difference between the Stark Law and the Anti-Kickback Statute?
A. Stark Law is a criminal statute; AKS is strictly civil
B. Stark Law applies to any referral; AKS only applies to physician referrals
C. Stark Law is a strict liability statute; AKS requires proof of intent
, D. There is no functional difference between the two
Answer: C
Conceptual Explanation: Stark Law (Physician Self-Referral Law) is a strict liability
statute, meaning intent does not matter. AKS requires proof of ‘knowing and willful’ intent.
5. A ‘Qui Tam’ action is brought by a private individual, known as a ‘relator’, on behalf of:
A. A private medical practice
B. The American Medical Association
C. The Government
D. The Patient Protection and Affordable Care Act council
Answer: C
Conceptual Explanation: Qui Tam provisions of the False Claims Act allow whistleblowers
(relators) to sue on behalf of the government for fraud and share in the recovery.
6. Which OIG document identifies the specific areas of concern for health care fraud in a given
year?
A. The Monthly Report
B. The Exclusion List
C. The Annual Work Plan
D. The Corporate Integrity Agreement
