AHIP FRAUD WASTE AND ABUSE EXAM NEWEST 2025 ACTUAL EXAM COMPLETE 150
QUESTIONS AND CORRECT DETAILED ANSWERS (VERIFIED ANSWERS) |ALREADY GRADED
A+
Which of the
ANSWERS) followingGRADED
|ALREADY requires A+
intent to obtain payment and the knowledge that the actions
are wrong? - (ANSWER)Fraud
Which of the following is not potentially a penalty for violation of the law or regulation
prohibiting fraud, waste and abuse (fwa)? - (ANSWER)Deportation
A person comes into your pharmacy to drop off a prescription for a beneficiary who is a regular
customer. The prescription is for a controlled substance with a quantity of 160. This beneficiary
normally receives a quantity of 60, not 160. You review the prescription and have concerns
about the possible forgery. What is your next step? - (ANSWER)Call the prescriber to verify the
谢谢谢
quantity
谢
Your job is to submit risk diagnosis to the centers for Medicare & medicaid services (cms) for 谢谢
the purpose of payment. As part of this job you verify, through a certain process, that the data
is accurate. Your immediate supervisor tells you to ignore the sponsors process and to
adjust/add risk diagnosis codes for certain individuals. What should you do? - (ANSWER)Report
the incident to the compliance department (via compliance hotline or other mechanism)
You are in charge of payment of claims submitted by providers. You notice a certain diagnostic
provider ("doe diagnostics") requested a substantial payment for a large number of members.
Many of these claims are for certain procedure. You review the same type of procedure for
other diagnostic providers and realize that doe diagnostics' claim far exceed any other provider
that you reviewed. What should you do? - (ANSWER)Consult with your immediate supervisor
for the next steps or contact the compliance department (via compliance hotline, special
investigation unit (siu), or other mechanism)
You are performing a regular inventory of the controlled substances in the pharmacy. You
discover a minor inventory discrepancy. What should you do? - (ANSWER)Follow your
pharmacys procedures
QUESTIONS AND CORRECT DETAILED ANSWERS (VERIFIED ANSWERS) |ALREADY GRADED
A+
Which of the
ANSWERS) followingGRADED
|ALREADY requires A+
intent to obtain payment and the knowledge that the actions
are wrong? - (ANSWER)Fraud
Which of the following is not potentially a penalty for violation of the law or regulation
prohibiting fraud, waste and abuse (fwa)? - (ANSWER)Deportation
A person comes into your pharmacy to drop off a prescription for a beneficiary who is a regular
customer. The prescription is for a controlled substance with a quantity of 160. This beneficiary
normally receives a quantity of 60, not 160. You review the prescription and have concerns
about the possible forgery. What is your next step? - (ANSWER)Call the prescriber to verify the
谢谢谢
quantity
谢
Your job is to submit risk diagnosis to the centers for Medicare & medicaid services (cms) for 谢谢
the purpose of payment. As part of this job you verify, through a certain process, that the data
is accurate. Your immediate supervisor tells you to ignore the sponsors process and to
adjust/add risk diagnosis codes for certain individuals. What should you do? - (ANSWER)Report
the incident to the compliance department (via compliance hotline or other mechanism)
You are in charge of payment of claims submitted by providers. You notice a certain diagnostic
provider ("doe diagnostics") requested a substantial payment for a large number of members.
Many of these claims are for certain procedure. You review the same type of procedure for
other diagnostic providers and realize that doe diagnostics' claim far exceed any other provider
that you reviewed. What should you do? - (ANSWER)Consult with your immediate supervisor
for the next steps or contact the compliance department (via compliance hotline, special
investigation unit (siu), or other mechanism)
You are performing a regular inventory of the controlled substances in the pharmacy. You
discover a minor inventory discrepancy. What should you do? - (ANSWER)Follow your
pharmacys procedures
