AHFI (Accredited Health Care Fraud Investigator) Exam QUESTIONS AND CORRECT
ANSWERS WITH RATIONALES
Exam coverage
• Unusual billing patterns can warrant further investigation when inconsistent with documented
services
• Investigations should begin with defined allegations scope objectives and an evidence plan
• Claims data can be compared with records coding and documented services
• Authenticated records improve evidence reliability and traceability
• Interviews should be planned documented and conducted objectively
• Data analysis can reveal duplicates outliers and unusual relationships
• Coding should correspond to documented services and applicable rules
• Investigators must consider applicable legal regulatory and contractual requirements
• Case files should preserve chronology evidence and analytical steps
• Professional investigators should protect confidentiality and avoid unsupported conclusions
,1. When evaluating this situation, which statement best applies because unusual billing
patterns can warrant further investigation when inconsistent with documented services
Which answer best applies the underlying health care fraud investigation principle in
this situation?
A. Unusual billing patterns can warrant further investigation when inconsistent with
documented services.
B. Claims data can be compared with records coding and documented services.
C. Investigations should begin with defined allegations scope objectives and an evidence plan.
D. Authenticated records improve evidence reliability and traceability.
Correct answer: A
Rationale: The correct choice is supported because unusual billing patterns can warrant
further investigation when inconsistent with documented services. The other options describe
related concepts but do not directly address the principle tested in this question.
2. Which response best demonstrates understanding of how investigations should
begin with defined allegations scope objectives and an evidence plan Which answer
best applies the underlying health care fraud investigation principle in this situation?
A. Interviews should be planned documented and conducted objectively.
B. Claims data can be compared with records coding and documented services.
C. Investigations should begin with defined allegations scope objectives and an evidence plan.
D. Authenticated records improve evidence reliability and traceability.
,Correct answer: C
Rationale: The correct choice is supported because investigations should begin with defined
allegations scope objectives and an evidence plan. The other options describe related
concepts but do not directly address the principle tested in this question.
3. An inspector is reviewing the following issue; which explanation is most accurate
because claims data can be compared with records coding and documented services
Which answer best applies the underlying health care fraud investigation principle in
this situation?
A. Claims data can be compared with records coding and documented services.
B. Authenticated records improve evidence reliability and traceability.
C. Interviews should be planned documented and conducted objectively.
D. Data analysis can reveal duplicates outliers and unusual relationships.
Correct answer: A
Rationale: The correct choice is supported because claims data can be compared with records
coding and documented services. The other options describe related concepts but do not
directly address the principle tested in this question.
4. Which option best describes the relationship between the requirement and the result
when authenticated records improve evidence reliability and traceability Which answer
best applies the underlying health care fraud investigation principle in this situation?
A. Interviews should be planned documented and conducted objectively.
, B. Authenticated records improve evidence reliability and traceability.
C. Data analysis can reveal duplicates outliers and unusual relationships.
D. Coding should correspond to documented services and applicable rules.
Correct answer: B
Rationale: The correct choice is supported because authenticated records improve evidence
reliability and traceability. The other options describe related concepts but do not directly
address the principle tested in this question.
5. A technician must decide how to proceed; which statement provides the soundest
basis because interviews should be planned documented and conducted objectively
Which answer best applies the underlying health care fraud investigation principle in
this situation?
A. Interviews should be planned documented and conducted objectively.
B. Data analysis can reveal duplicates outliers and unusual relationships.
C. Coding should correspond to documented services and applicable rules.
D. Investigators must consider applicable legal regulatory and contractual requirements.
Correct answer: A
Rationale: The correct choice is supported because interviews should be planned documented
and conducted objectively. The other options describe related concepts but do not directly
address the principle tested in this question.
ANSWERS WITH RATIONALES
Exam coverage
• Unusual billing patterns can warrant further investigation when inconsistent with documented
services
• Investigations should begin with defined allegations scope objectives and an evidence plan
• Claims data can be compared with records coding and documented services
• Authenticated records improve evidence reliability and traceability
• Interviews should be planned documented and conducted objectively
• Data analysis can reveal duplicates outliers and unusual relationships
• Coding should correspond to documented services and applicable rules
• Investigators must consider applicable legal regulatory and contractual requirements
• Case files should preserve chronology evidence and analytical steps
• Professional investigators should protect confidentiality and avoid unsupported conclusions
,1. When evaluating this situation, which statement best applies because unusual billing
patterns can warrant further investigation when inconsistent with documented services
Which answer best applies the underlying health care fraud investigation principle in
this situation?
A. Unusual billing patterns can warrant further investigation when inconsistent with
documented services.
B. Claims data can be compared with records coding and documented services.
C. Investigations should begin with defined allegations scope objectives and an evidence plan.
D. Authenticated records improve evidence reliability and traceability.
Correct answer: A
Rationale: The correct choice is supported because unusual billing patterns can warrant
further investigation when inconsistent with documented services. The other options describe
related concepts but do not directly address the principle tested in this question.
2. Which response best demonstrates understanding of how investigations should
begin with defined allegations scope objectives and an evidence plan Which answer
best applies the underlying health care fraud investigation principle in this situation?
A. Interviews should be planned documented and conducted objectively.
B. Claims data can be compared with records coding and documented services.
C. Investigations should begin with defined allegations scope objectives and an evidence plan.
D. Authenticated records improve evidence reliability and traceability.
,Correct answer: C
Rationale: The correct choice is supported because investigations should begin with defined
allegations scope objectives and an evidence plan. The other options describe related
concepts but do not directly address the principle tested in this question.
3. An inspector is reviewing the following issue; which explanation is most accurate
because claims data can be compared with records coding and documented services
Which answer best applies the underlying health care fraud investigation principle in
this situation?
A. Claims data can be compared with records coding and documented services.
B. Authenticated records improve evidence reliability and traceability.
C. Interviews should be planned documented and conducted objectively.
D. Data analysis can reveal duplicates outliers and unusual relationships.
Correct answer: A
Rationale: The correct choice is supported because claims data can be compared with records
coding and documented services. The other options describe related concepts but do not
directly address the principle tested in this question.
4. Which option best describes the relationship between the requirement and the result
when authenticated records improve evidence reliability and traceability Which answer
best applies the underlying health care fraud investigation principle in this situation?
A. Interviews should be planned documented and conducted objectively.
, B. Authenticated records improve evidence reliability and traceability.
C. Data analysis can reveal duplicates outliers and unusual relationships.
D. Coding should correspond to documented services and applicable rules.
Correct answer: B
Rationale: The correct choice is supported because authenticated records improve evidence
reliability and traceability. The other options describe related concepts but do not directly
address the principle tested in this question.
5. A technician must decide how to proceed; which statement provides the soundest
basis because interviews should be planned documented and conducted objectively
Which answer best applies the underlying health care fraud investigation principle in
this situation?
A. Interviews should be planned documented and conducted objectively.
B. Data analysis can reveal duplicates outliers and unusual relationships.
C. Coding should correspond to documented services and applicable rules.
D. Investigators must consider applicable legal regulatory and contractual requirements.
Correct answer: A
Rationale: The correct choice is supported because interviews should be planned documented
and conducted objectively. The other options describe related concepts but do not directly
address the principle tested in this question.
