Fraud, Waste, Abuse - 2, Fraud Waste and Abuse, Preventing Fraud, Abuse &
Waste, Fraud, Abuse, and Waste, Fraud Waste and Abuse AHIP, fraud, waste,
and abuse prevention Exam 2025-2026
e - ANSWER Methods to make the reports on possible FWA include:
a. Telephone hotlines
b. Mail Drops
c. Reporting in person to the compliance departments/supervisor
d. Special Investigations Units (SIUs)
e. All of the above
false - ANSWER In case a corrective action plan has been initiated, then there must be
an annual watch of the corrective actions made to ensure they work properly.
:
True False
false - ANSWER It is liable for any person who knowingly submits false claims to the
Government to pay five times the Government's damages caused by the violator plus a
penalty.
:
True False
true - ANSWER The following are some examples of the matters that need to be reported
to a Compliance Department: suspected Fraud, Waste, and Abuse (FWA); a health
privacy violation, and unethical behavior/employee misconduct.
:
True False
,True - ANSWER Bribes or kickbacks of any kind for services that are paid under a
Federal health care program - which includes Medicare - constitute fraud by both the
person making and the person receiving them.
:
True False
True - ANSWER Waste includes, but is not limited to, the overutilization of services, or
other practices that, directly or indirectly, result in unnecessary costs to the Medicare
Program.
:
True False
ACA Section 1557 provides expanded protection against discrimination on the basis of-
ANSWER sex
Section 1557 of the Affordable Care Act applies to- ANSWER c. all health programs and
activities administered by or receiving federal financial assistance from HHS. Correct
Which of the following Medicare programs fall within the coverage of ACA Section
1557?- ANSWER a. Parts A, C, and D, but not B. Correct
Under ACA Section 1557, prohibited actions include- ANSWER d. eligibility, claims and
marketing. Correct
Under ACA Section 1557, an individual- ANSWER c. shall not be discriminated against
based on her lawful or unlawful status as an immigrant or on her limited English
proficiency. Correct
Under ACA Section 1557, a health plan - ANSWER d. is not allowed to deny benefits to
LEP beneficiaries and must provide language access for them at no cost. Correct
, Which of the following practices are you most likely able to take when working with a
limited English proficient individual? - ANSWER a. Use the services of a child interpreter
in an emergency. Correct
For purposes of ACA Section 1557, discrimination based on sex includes - ANSWER c.
sex, pregnancy, sex stereotypes, or gender identity. Correct
Under ACA Section 1557, a health plan sold through a state exchange may, based on an
individual's age, - ANSWER d. charge higher premiums. Correct
ACA Section 1557 rules for disability address - ANSWER d. Policies and procedures,
physical access, and communication. Correct
Which area of potential discrimination is not typically covered under ACA Section 1557?
- ANSWER c. Employment (except the offering of health insurance). Correct
c. a health plan may revoke an agent or broker's appointment with the health plan.
Correct
For a health plan, what are the possible consequences of violations of ACA Section
1557? - ANSWER b. Loss of federal business and compensatory damages. Correct
If a health plan violates ACA Section 1557 nondiscrimination protections, it may be-
ANSWER c. required to take corrective action and sometimes pay damages, and it may
be sued by individuals. Correct
Ways to report potential Fraud, Waste, and Abuse (FWA) include: - ANSWER e. All of the
above Correct
Once a corrective action plan has been instituted, the corrective actions must be
tracked annually to assess their effectiveness. -ANSWER False
Any person who knowingly presents false claims to the Government shall be liable for
Waste, Fraud, Abuse, and Waste, Fraud Waste and Abuse AHIP, fraud, waste,
and abuse prevention Exam 2025-2026
e - ANSWER Methods to make the reports on possible FWA include:
a. Telephone hotlines
b. Mail Drops
c. Reporting in person to the compliance departments/supervisor
d. Special Investigations Units (SIUs)
e. All of the above
false - ANSWER In case a corrective action plan has been initiated, then there must be
an annual watch of the corrective actions made to ensure they work properly.
:
True False
false - ANSWER It is liable for any person who knowingly submits false claims to the
Government to pay five times the Government's damages caused by the violator plus a
penalty.
:
True False
true - ANSWER The following are some examples of the matters that need to be reported
to a Compliance Department: suspected Fraud, Waste, and Abuse (FWA); a health
privacy violation, and unethical behavior/employee misconduct.
:
True False
,True - ANSWER Bribes or kickbacks of any kind for services that are paid under a
Federal health care program - which includes Medicare - constitute fraud by both the
person making and the person receiving them.
:
True False
True - ANSWER Waste includes, but is not limited to, the overutilization of services, or
other practices that, directly or indirectly, result in unnecessary costs to the Medicare
Program.
:
True False
ACA Section 1557 provides expanded protection against discrimination on the basis of-
ANSWER sex
Section 1557 of the Affordable Care Act applies to- ANSWER c. all health programs and
activities administered by or receiving federal financial assistance from HHS. Correct
Which of the following Medicare programs fall within the coverage of ACA Section
1557?- ANSWER a. Parts A, C, and D, but not B. Correct
Under ACA Section 1557, prohibited actions include- ANSWER d. eligibility, claims and
marketing. Correct
Under ACA Section 1557, an individual- ANSWER c. shall not be discriminated against
based on her lawful or unlawful status as an immigrant or on her limited English
proficiency. Correct
Under ACA Section 1557, a health plan - ANSWER d. is not allowed to deny benefits to
LEP beneficiaries and must provide language access for them at no cost. Correct
, Which of the following practices are you most likely able to take when working with a
limited English proficient individual? - ANSWER a. Use the services of a child interpreter
in an emergency. Correct
For purposes of ACA Section 1557, discrimination based on sex includes - ANSWER c.
sex, pregnancy, sex stereotypes, or gender identity. Correct
Under ACA Section 1557, a health plan sold through a state exchange may, based on an
individual's age, - ANSWER d. charge higher premiums. Correct
ACA Section 1557 rules for disability address - ANSWER d. Policies and procedures,
physical access, and communication. Correct
Which area of potential discrimination is not typically covered under ACA Section 1557?
- ANSWER c. Employment (except the offering of health insurance). Correct
c. a health plan may revoke an agent or broker's appointment with the health plan.
Correct
For a health plan, what are the possible consequences of violations of ACA Section
1557? - ANSWER b. Loss of federal business and compensatory damages. Correct
If a health plan violates ACA Section 1557 nondiscrimination protections, it may be-
ANSWER c. required to take corrective action and sometimes pay damages, and it may
be sued by individuals. Correct
Ways to report potential Fraud, Waste, and Abuse (FWA) include: - ANSWER e. All of the
above Correct
Once a corrective action plan has been instituted, the corrective actions must be
tracked annually to assess their effectiveness. -ANSWER False
Any person who knowingly presents false claims to the Government shall be liable for
