Ahip fraud waste & abuse EXAM QUESTIONS AND ANSWERS (GRADED A+)

Which of the following requires intent to obtain payment and the knowledge that the actions are wrong? - ANSWERFraud Which of the following is not potentially a penalty for violation of the law or regulation prohibiting fraud, waste and abuse (fwa)? - ANSWERDeportation Your job is to submit 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 sponsors process and to adjust/add risk diagnosis codes for certain individuals. What should you do? - ANSWERReport the incident to the compliance department (via compliance hotline or other mechanism) 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? - ANSWERCall the prescriber to verify the quantity You are performing a regular inventory of the controlled substances in the pharmacy. You discover a minor inventory discrepancy. What should you do? - ANSWERFollow your pharmacys procedures 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? - ANSWERConsult with your immediate supervisor for the next steps or contact the compliance department (via compliance hotline, special investigation unit (siu), or other mechanism)