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AHIP Discrimination, Fraud, Waste & Abuse Training Practice Exam (100 Questions)
Section 1: Fraud Fundamentals (Questions 1–20)
1. Which of the following best defines fraud in the Medicare program?
A. Making a mistake when billing Medicare
B. Knowingly submitting false claims or making misrepresentations to obtain payment
C. Providing unnecessary services due to lack of knowledge
D. Overpaying a provider for a service
Answer: B
2. What is the primary difference between fraud and abuse in Medicare?
A. Fraud is intentional; abuse involves actions inconsistent with accepted practices and may
be unintentional
B. Fraud is unintentional; abuse is intentional
C. Fraud involves patients; abuse involves providers
D. There is no difference
Answer: A
3. A physician bills Medicare for a higher-level service than what was actually provided.
This is an example of:
A. Waste
B. Abuse
C. Fraud
D. Error
Answer: C (Upcoding is intentional misrepresentation)
4. Which of the following requires intent to obtain payment and the knowledge the
actions are wrong?
A. Waste
B. Abuse
C. Fraud
D. Error
Answer: C
5. Any person who knowingly submits false claims to the Government is liable for how
many times the Government's damages?
A. Two times
B. Three times
C. Five times
D. Ten times
Answer: C (Plus a penalty per claim)
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6. Bribes or kickbacks for services paid under a Federal health care program constitute
fraud by:
A. Only the person making the bribe
B. Only the person receiving the bribe
C. Both the person making and the person receiving them
D. Neither party
Answer: C
7. Which law makes it a criminal offense to knowingly offer, pay, solicit, or receive
remuneration to induce referrals?
A. HIPAA
B. The Federal Anti-Kickback Statute
C. The Civil False Claims Act
D. The Stark Law
Answer: B
8. What are the penalties for violating the Federal Anti-Kickback Statute?
A. Fines only
B. Imprisonment only
C. Fines up to $25,000, imprisonment up to 5 years, or both
D. No penalties
Answer: C
9. Which of the following is an example of fraud committed by a pharmacist?
A. Dispensing a generic instead of a brand-name drug
B. Deliberately putting fewer pills in the bottle and selling the extra pills
C. Requesting a formulary exception
D. Changing a formulary
Answer: B
10. The Stark Law (Physician Self-Referral Law) prohibits physicians from referring patients
to entities with which they have:
A. A personal friendship
B. A financial relationship
C. A professional association
D. A patient relationship
Answer: B
11. What is an example of a Stark Law violation?
A. Dr. Winters refers her patients to an independent laboratory owned by her husband
B. Dr. Winters refers her patients to the hospital where she works
C. Dr. Winters refers her patients to a colleague
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D. Dr. Winters refers her patients to a specialist
Answer: A
12. Penalties for physicians who violate the Stark Law include:
A. Fines only
B. Exclusion from participation in ALL Federal healthcare programs
C. Warning letters only
D. No penalties
Answer: B
13. What is the "human cost" of Medicare fraud, waste, and abuse?
A. Reduced access to care for beneficiaries
B. Increased premiums for beneficiaries
C. Undermining trust in the Medicare program
D. All of the above
Answer: D
14. Which of the following is NOT a penalty for violating FWA laws?
A. Criminal penalties
B. Civil monetary penalties
C. Exclusion from Federal healthcare programs
D. Deportation
Answer: D
15. Some laws governing Medicare Part C and D FWA include:
A. HIPAA
B. Civil False Claims Act
C. Anti-Kickback Statute
D. All of the above
Answer: D
16. What does the Civil False Claims Act prohibit?
A. Making mistakes in billing
B. Knowingly submitting false claims to the Government
C. Requesting formulary exceptions
D. Changing formularies
Answer: B
17. What is the role of the Medicare Drug Integrity Contractor (MEDIC)?
A. To process claims
B. To monitor and analyze information to help identify potential fraud
C. To enroll beneficiaries
D. To market Medicare plans
Answer: B
AHIP Discrimination, Fraud, Waste & Abuse Training Practice Exam (100 Questions)
Section 1: Fraud Fundamentals (Questions 1–20)
1. Which of the following best defines fraud in the Medicare program?
A. Making a mistake when billing Medicare
B. Knowingly submitting false claims or making misrepresentations to obtain payment
C. Providing unnecessary services due to lack of knowledge
D. Overpaying a provider for a service
Answer: B
2. What is the primary difference between fraud and abuse in Medicare?
A. Fraud is intentional; abuse involves actions inconsistent with accepted practices and may
be unintentional
B. Fraud is unintentional; abuse is intentional
C. Fraud involves patients; abuse involves providers
D. There is no difference
Answer: A
3. A physician bills Medicare for a higher-level service than what was actually provided.
This is an example of:
A. Waste
B. Abuse
C. Fraud
D. Error
Answer: C (Upcoding is intentional misrepresentation)
4. Which of the following requires intent to obtain payment and the knowledge the
actions are wrong?
A. Waste
B. Abuse
C. Fraud
D. Error
Answer: C
5. Any person who knowingly submits false claims to the Government is liable for how
many times the Government's damages?
A. Two times
B. Three times
C. Five times
D. Ten times
Answer: C (Plus a penalty per claim)
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6. Bribes or kickbacks for services paid under a Federal health care program constitute
fraud by:
A. Only the person making the bribe
B. Only the person receiving the bribe
C. Both the person making and the person receiving them
D. Neither party
Answer: C
7. Which law makes it a criminal offense to knowingly offer, pay, solicit, or receive
remuneration to induce referrals?
A. HIPAA
B. The Federal Anti-Kickback Statute
C. The Civil False Claims Act
D. The Stark Law
Answer: B
8. What are the penalties for violating the Federal Anti-Kickback Statute?
A. Fines only
B. Imprisonment only
C. Fines up to $25,000, imprisonment up to 5 years, or both
D. No penalties
Answer: C
9. Which of the following is an example of fraud committed by a pharmacist?
A. Dispensing a generic instead of a brand-name drug
B. Deliberately putting fewer pills in the bottle and selling the extra pills
C. Requesting a formulary exception
D. Changing a formulary
Answer: B
10. The Stark Law (Physician Self-Referral Law) prohibits physicians from referring patients
to entities with which they have:
A. A personal friendship
B. A financial relationship
C. A professional association
D. A patient relationship
Answer: B
11. What is an example of a Stark Law violation?
A. Dr. Winters refers her patients to an independent laboratory owned by her husband
B. Dr. Winters refers her patients to the hospital where she works
C. Dr. Winters refers her patients to a colleague
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D. Dr. Winters refers her patients to a specialist
Answer: A
12. Penalties for physicians who violate the Stark Law include:
A. Fines only
B. Exclusion from participation in ALL Federal healthcare programs
C. Warning letters only
D. No penalties
Answer: B
13. What is the "human cost" of Medicare fraud, waste, and abuse?
A. Reduced access to care for beneficiaries
B. Increased premiums for beneficiaries
C. Undermining trust in the Medicare program
D. All of the above
Answer: D
14. Which of the following is NOT a penalty for violating FWA laws?
A. Criminal penalties
B. Civil monetary penalties
C. Exclusion from Federal healthcare programs
D. Deportation
Answer: D
15. Some laws governing Medicare Part C and D FWA include:
A. HIPAA
B. Civil False Claims Act
C. Anti-Kickback Statute
D. All of the above
Answer: D
16. What does the Civil False Claims Act prohibit?
A. Making mistakes in billing
B. Knowingly submitting false claims to the Government
C. Requesting formulary exceptions
D. Changing formularies
Answer: B
17. What is the role of the Medicare Drug Integrity Contractor (MEDIC)?
A. To process claims
B. To monitor and analyze information to help identify potential fraud
C. To enroll beneficiaries
D. To market Medicare plans
Answer: B
