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AHIP - Discrimination, Fraud, Waste, & Abuse - 2026
Stuvia-9318740-ahip-discrimination-fraud-waste-and-abuse-training-20252026-complete-exam-question-and-solution-guide-com
Study online at https://quizlet.com/_hh0s77
1. Under ACA Section 1557, a health plan premium charge higher premiums.
sold through a state exchange may, based on an
individual's age and
2. As a result of violations of ACA Section 1557 a health plan may revoke an agent
nondiscrimination rules, or broker's appointment with the
health plan.
3. ACA Section 1557 rules for disability concern policies and procedures, physical ac-
cess, and communication.
4. Which Medicare programs are covered by ACA Parts A, C, and D, and Part B.
Section 1557 under the Biden Administration's
Final Rule (2024)?
5. Which of the following statements best de- Section 1557 incorporates earlier
scribes Section 1557 of the Affordable Care Act civil rights protections in regard to
(ACA)? race, color, national origin, disability,
age and sex.
6. Section 1557 of the Affordable Care Act applies all health programs and activities ad-
to ministered by or receiving federal fi-
nancial assistance from HHS.
7. Which of the following would be considered per- Broker Mary Jones has recruited a
missible under Section 1557? diverse workforce. She encourages
her agents to prospect through com-
munity-based marketing and within
their community of influence.
8. Which of these actions is most likely to be per- Allowing a child to interpret in an
mitted in dealing with a person with limited Eng- emergency.
lish proficiency?
1/8
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AHIP - Discrimination, Fraud, Waste, & Abuse - 2026
Stuvia-9318740-ahip-discrimination-fraud-waste-and-abuse-training-20252026-complete-exam-question-and-solution-guide-com
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9. Which of the following statements best de- Entities principally engaged in
scribes the scope of operations subject to Sec- health care, which includes health
tion 1557 under the Final Rule (2024) of the insurers, must comply with Section
Biden Administration? 1557 for all programs they offer.
10. For a health plan, what are the possible conse- Loss of federal business and com-
quences of violations of ACA Section 1557? pensatory damages.
11. Auxiliary aids and services must be provided to I, II, III, and IV
individuals with disabilities, such as those suf-
fering from vision or hearing impairments, free
of charge, and in a timely manner. Auxiliary aids
and services include which of the following:
I. large print materials
II. qualified sign language interpreters
III. braille materials and displays
IV. screen reader software
12. Under ACA Section 1557, a health plan cannot deny coverage to LEP indi-
viduals and is required to provide
language assistance to them, free of
charge.
13. Under Section 1557, the 2020 Final Rule issued as biologic sex only, meaning
during the Trump Administration sex was initial- whether a person was determined to
ly defined____________ be male or female at birth.
14. Which entity enforces Section 1557 for pro- The Office of Civil Rights (OCR) of
grams that receive funding from and are admin- HHS.
istered by HHS?
15. You are performing a regular inventory of the Follow your pharmacy's procedures.
controlled substances in the pharmacy. You
2/8
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AHIP - Discrimination, Fraud, Waste, & Abuse - 2026
Stuvia-9318740-ahip-discrimination-fraud-waste-and-abuse-training-20252026-complete-exam-question-and-solution-guide-com
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discover a minor inventory discrepancy. What
should you do?
16. A person drops off a prescription for a beneficia- Call the prescriber to verify the quan-
ry who is a "regular" customer. The prescription tity
is for a controlled substance with a quantity of
160. This beneficiary normally receives a quan-
tity of 60, not 160. You review the prescription
and have concerns about possible forgery. What
is your next step?
17. Which of the following requires intent to ob- Fraud
tain payment and the knowledge the actions are
wrong?
18. You are in charge of paying claims submit- Consult with your immediate super-
ted by providers. You notice a certain diag- visor for next steps or contact the
nostic provider ("Doe Diagnostics") requested a compliance department (via compli-
substantial payment for a large patient group. ance hotline, Special Investigations
Many of these claims are for a certain proce- Unit [SIU], or other mechanism)
dure. You review the same type of procedure for
other diagnostic providers and realize Doe Di-
agnostics' claims far exceed any other provider
you reviewed. What should you do?
19. Your job is to submit a risk diagnosis to the Report the incident to the com-
Centers for Medicare & Medicaid Services (CMS) pliance department (via compliance
for the purpose of payment. As part of this job, hotline or other mechanism)
you use a process to verify the data is accurate.
Your immediate supervisor tells you to ignore
the Sponsor's process and to adjust or add risk
diagnosis codes for certain individuals. What
should you do?
3/8
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Distribution of this document is illegal extra per year?
written by
mib01
The Marketplace to Buy and Sell your Study Material
At Stuvia, you will find the best notes, summaries, flashcards & other study material. Search for your
school or uni and find the study material you need.
www.stuvia.com
Stuvia-9318740-ahip-discrimination-fraud-waste-and-abuse-training-20252026-complete-exam-question-and-solution-guide-com
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Distribution of this document is illegal extra per year?
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AHIP - Discrimination, Fraud, Waste, & Abuse - 2026
Stuvia-9318740-ahip-discrimination-fraud-waste-and-abuse-training-20252026-complete-exam-question-and-solution-guide-com
Study online at https://quizlet.com/_hh0s77
1. Under ACA Section 1557, a health plan premium charge higher premiums.
sold through a state exchange may, based on an
individual's age and
2. As a result of violations of ACA Section 1557 a health plan may revoke an agent
nondiscrimination rules, or broker's appointment with the
health plan.
3. ACA Section 1557 rules for disability concern policies and procedures, physical ac-
cess, and communication.
4. Which Medicare programs are covered by ACA Parts A, C, and D, and Part B.
Section 1557 under the Biden Administration's
Final Rule (2024)?
5. Which of the following statements best de- Section 1557 incorporates earlier
scribes Section 1557 of the Affordable Care Act civil rights protections in regard to
(ACA)? race, color, national origin, disability,
age and sex.
6. Section 1557 of the Affordable Care Act applies all health programs and activities ad-
to ministered by or receiving federal fi-
nancial assistance from HHS.
7. Which of the following would be considered per- Broker Mary Jones has recruited a
missible under Section 1557? diverse workforce. She encourages
her agents to prospect through com-
munity-based marketing and within
their community of influence.
8. Which of these actions is most likely to be per- Allowing a child to interpret in an
mitted in dealing with a person with limited Eng- emergency.
lish proficiency?
1/8
Stuvia-9318740-ahip-discrimination-fraud-waste-and-abuse-training-20252026-complete-exam-question-and-solution-guide-com
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Distribution of this document is illegal extra per year?
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AHIP - Discrimination, Fraud, Waste, & Abuse - 2026
Stuvia-9318740-ahip-discrimination-fraud-waste-and-abuse-training-20252026-complete-exam-question-and-solution-guide-com
Study online at https://quizlet.com/_hh0s77
9. Which of the following statements best de- Entities principally engaged in
scribes the scope of operations subject to Sec- health care, which includes health
tion 1557 under the Final Rule (2024) of the insurers, must comply with Section
Biden Administration? 1557 for all programs they offer.
10. For a health plan, what are the possible conse- Loss of federal business and com-
quences of violations of ACA Section 1557? pensatory damages.
11. Auxiliary aids and services must be provided to I, II, III, and IV
individuals with disabilities, such as those suf-
fering from vision or hearing impairments, free
of charge, and in a timely manner. Auxiliary aids
and services include which of the following:
I. large print materials
II. qualified sign language interpreters
III. braille materials and displays
IV. screen reader software
12. Under ACA Section 1557, a health plan cannot deny coverage to LEP indi-
viduals and is required to provide
language assistance to them, free of
charge.
13. Under Section 1557, the 2020 Final Rule issued as biologic sex only, meaning
during the Trump Administration sex was initial- whether a person was determined to
ly defined____________ be male or female at birth.
14. Which entity enforces Section 1557 for pro- The Office of Civil Rights (OCR) of
grams that receive funding from and are admin- HHS.
istered by HHS?
15. You are performing a regular inventory of the Follow your pharmacy's procedures.
controlled substances in the pharmacy. You
2/8
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Downloaded by: mib01 | Want to earn $1.236
Distribution of this document is illegal extra per year?
, Stuvia.com - The Marketplace to Buy and Sell your Study Material
AHIP - Discrimination, Fraud, Waste, & Abuse - 2026
Stuvia-9318740-ahip-discrimination-fraud-waste-and-abuse-training-20252026-complete-exam-question-and-solution-guide-com
Study online at https://quizlet.com/_hh0s77
discover a minor inventory discrepancy. What
should you do?
16. A person drops off a prescription for a beneficia- Call the prescriber to verify the quan-
ry who is a "regular" customer. The prescription tity
is for a controlled substance with a quantity of
160. This beneficiary normally receives a quan-
tity of 60, not 160. You review the prescription
and have concerns about possible forgery. What
is your next step?
17. Which of the following requires intent to ob- Fraud
tain payment and the knowledge the actions are
wrong?
18. You are in charge of paying claims submit- Consult with your immediate super-
ted by providers. You notice a certain diag- visor for next steps or contact the
nostic provider ("Doe Diagnostics") requested a compliance department (via compli-
substantial payment for a large patient group. ance hotline, Special Investigations
Many of these claims are for a certain proce- Unit [SIU], or other mechanism)
dure. You review the same type of procedure for
other diagnostic providers and realize Doe Di-
agnostics' claims far exceed any other provider
you reviewed. What should you do?
19. Your job is to submit a risk diagnosis to the Report the incident to the com-
Centers for Medicare & Medicaid Services (CMS) pliance department (via compliance
for the purpose of payment. As part of this job, hotline or other mechanism)
you use a process to verify the data is accurate.
Your immediate supervisor tells you to ignore
the Sponsor's process and to adjust or add risk
diagnosis codes for certain individuals. What
should you do?
3/8
Stuvia-9318740-ahip-discrimination-fraud-waste-and-abuse-training-20252026-complete-exam-question-and-solution-guide-com
Downloaded by: mib01 | Want to earn $1.236
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