AHIP 2025/2026 Final Exam Updated Questions and
Verified Answers, 100% Guarantee Pass.
Which of the following requires 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 a law or regulation
prohibiting Fraud, Waste, and Abuse (FWA)? - ANSWER-Deportation
A person comes to 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 possible forgery. What is your next step? - ANSWER-Call the
prescriber to verify the quantity
Your job is to submit a risk diagnosis to the Centers for Medicare & Medicaid Services
(CMS) for 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
Sponsor's 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 a certain procedure. You review the
same type of procedure for other diagnostic providers and realize that Doe Diagnostics'
claims far exceed any other provider that you reviewed. What should you do? -
ANSWER-Consult with your immediate supervisor for next steps or contact the
compliance department (via compliance hotline, Special Investigations 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 pharmacy's procedures
Compliance is the responsibility of the Compliance Officer, Compliance Committee, and
Upper Management only. - ANSWER-False
Ways to report a compliance issue include: - ANSWER-All of the above
What is the policy of non-retaliation? - ANSWER-Protects employees who, in good faith,
report suspected non-compliance
Verified Answers, 100% Guarantee Pass.
Which of the following requires 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 a law or regulation
prohibiting Fraud, Waste, and Abuse (FWA)? - ANSWER-Deportation
A person comes to 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 possible forgery. What is your next step? - ANSWER-Call the
prescriber to verify the quantity
Your job is to submit a risk diagnosis to the Centers for Medicare & Medicaid Services
(CMS) for 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
Sponsor's 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 a certain procedure. You review the
same type of procedure for other diagnostic providers and realize that Doe Diagnostics'
claims far exceed any other provider that you reviewed. What should you do? -
ANSWER-Consult with your immediate supervisor for next steps or contact the
compliance department (via compliance hotline, Special Investigations 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 pharmacy's procedures
Compliance is the responsibility of the Compliance Officer, Compliance Committee, and
Upper Management only. - ANSWER-False
Ways to report a compliance issue include: - ANSWER-All of the above
What is the policy of non-retaliation? - ANSWER-Protects employees who, in good faith,
report suspected non-compliance
