2025 AHIP - Fraud, Waste, and Abuse
1. A individual drops off a prescription for a beneficiary who is a "normal" customer. The
prescription is for a managed substance with a quantity of a hundred and sixty. This
beneficiary commonly receives a quantity of 60, now not one hundred sixty. You
evaluation the prescription and feature concerns about viable forgery. What is your next
step? - ANS-Call the prescriber to verify the quantity
2. Abuse entails charge for gadgets or services while there's no felony entitlement to that
price and the provider has not knowingly or intentionally misrepresented facts to achieve
fee. - ANS-True
3. Any person who knowingly submits false claims to the Government is accountable for 5
instances the Government's damages because of the violator plus a penalty. -
ANS-False
4. Bribes or kickbacks of any type for offerings which might be paid under a Federal fitness
care application (which includes Medicare) constitute fraud by means of the character
making in addition to the man or woman receiving them. - ANS-True
5. Once a corrective action plan is started, the corrective action plan should be monitored
annually to make certain they may be powerful. - ANS-False
6. Some of the legal guidelines governing Medicare Part C and D fraud, waste, and abuse
(FWA) include the Health Insurance Portability and Accountability Act (HIPAA), the Civil
False Claims Act, the Anti-Kickback Statute, and the Criminal Health Care Fraud Statute.
- ANS-True
7. These are examples of issues that have to be suggested to a Compliance Department:
suspected fraud, waste, and abuse (FWA); potential fitness privateness violation,
unethical behavior, and worker misconduct. - ANS-True
8. Waste consists of any misuse of sources, which include the overuse of services or
different practices that without delay or indirectly result in pointless prices to the
Medicare Program. - ANS-True
9. Ways to file ability fraud, waste, and abuse (FWA) consist of: - ANS-All of the above
10. What are some of the penalties for violating fraud, waste, and abuse (FWA) laws? -
ANS-All of the above
11. Which of the following is NOT doubtlessly a penalty for violation of a regulation or law
prohibiting fraud, waste, and abuse (FWA)? - ANS-Deportation
12. Which of the subsequent requires intent to achieve payment and the know-how the
moves are incorrect? - ANS-Fraud
13. You are in charge of paying claims submitted via providers. You be aware a positive
diagnostic provider ("Doe Diagnostics") requested a sizeable payment for a large patient
institution. Many of these claims are for a sure technique. You assessment the same
kind of procedure for different diagnostic carriers and realise Doe Diagnostics' claims far
exceed every other issuer you reviewed. What have to you do? - ANS-Consult with your
1. A individual drops off a prescription for a beneficiary who is a "normal" customer. The
prescription is for a managed substance with a quantity of a hundred and sixty. This
beneficiary commonly receives a quantity of 60, now not one hundred sixty. You
evaluation the prescription and feature concerns about viable forgery. What is your next
step? - ANS-Call the prescriber to verify the quantity
2. Abuse entails charge for gadgets or services while there's no felony entitlement to that
price and the provider has not knowingly or intentionally misrepresented facts to achieve
fee. - ANS-True
3. Any person who knowingly submits false claims to the Government is accountable for 5
instances the Government's damages because of the violator plus a penalty. -
ANS-False
4. Bribes or kickbacks of any type for offerings which might be paid under a Federal fitness
care application (which includes Medicare) constitute fraud by means of the character
making in addition to the man or woman receiving them. - ANS-True
5. Once a corrective action plan is started, the corrective action plan should be monitored
annually to make certain they may be powerful. - ANS-False
6. Some of the legal guidelines governing Medicare Part C and D fraud, waste, and abuse
(FWA) include the Health Insurance Portability and Accountability Act (HIPAA), the Civil
False Claims Act, the Anti-Kickback Statute, and the Criminal Health Care Fraud Statute.
- ANS-True
7. These are examples of issues that have to be suggested to a Compliance Department:
suspected fraud, waste, and abuse (FWA); potential fitness privateness violation,
unethical behavior, and worker misconduct. - ANS-True
8. Waste consists of any misuse of sources, which include the overuse of services or
different practices that without delay or indirectly result in pointless prices to the
Medicare Program. - ANS-True
9. Ways to file ability fraud, waste, and abuse (FWA) consist of: - ANS-All of the above
10. What are some of the penalties for violating fraud, waste, and abuse (FWA) laws? -
ANS-All of the above
11. Which of the following is NOT doubtlessly a penalty for violation of a regulation or law
prohibiting fraud, waste, and abuse (FWA)? - ANS-Deportation
12. Which of the subsequent requires intent to achieve payment and the know-how the
moves are incorrect? - ANS-Fraud
13. You are in charge of paying claims submitted via providers. You be aware a positive
diagnostic provider ("Doe Diagnostics") requested a sizeable payment for a large patient
institution. Many of these claims are for a sure technique. You assessment the same
kind of procedure for different diagnostic carriers and realise Doe Diagnostics' claims far
exceed every other issuer you reviewed. What have to you do? - ANS-Consult with your
