AHIP FWA 200 ACTUAL QUESTIONS AND
CORRECT ANSWERS WITH RATIONALE
ALREADY GRADED A+
The AHIP Fraud, Waste, and Abuse (FWA) Exam is a critical component of
Medicare certification required for agents and brokers selling Medicare
Advantage and Part D plans. This comprehensive exam covers the
identification, prevention, and reporting of fraudulent activities within federal
healthcare programs. Key topics include the distinctions between fraud
(intentional deception), abuse (improper practices without intent), and waste
(unnecessary costs). The exam also addresses the False Claims Act, Anti-
Kickback Statute, HIPAA privacy requirements, and Section 1557
nondiscrimination provisions. Candidates must achieve a 90% passing score
within three attempts. Successful completion demonstrates understanding of
compliance obligations, ethical standards, and the importance of protecting
Medicare program integrity and beneficiary rights.
Question 1
Which of the following requires intent to obtain payment and the knowledge that
the actions are wrong?
A) Waste
B) Abuse
C) Fraud
D) Negligence
Correct Answer: C
Rationale: Fraud requires intent to obtain payment and the knowledge that the
actions are wrong. It is distinguished from abuse and waste by the intentional
deception for financial gain.
Question 2
,Which of the following is NOT a potential penalty for a violation of a law or
regulation prohibiting Fraud, Waste, and Abuse (FWA)?
A) Civil Monetary Penalties
B) Imprisonment
C) Exclusion from participation in all Federal health care programs
D) Deportation
Correct Answer: D
Rationale: While FWA violations can result in fines, imprisonment, and program
exclusion, deportation is not a standard penalty unless other immigration-related
offenses are involved.
Question 3
A person drops off a prescription for a controlled substance with a quantity of 160.
This beneficiary normally receives a quantity of 60. You have concerns about
possible forgery. What is your next step?
A) Fill the prescription for 160
B) Fill the prescription for 60
C) Call the prescriber to verify the quantity
D) Call the Sponsor's compliance department
E) Call law enforcement
Correct Answer: C
Rationale: Verification of suspicious prescriptions should begin with the
prescriber. Calling the prescriber to verify the quantity ensures patient safety,
prevents potential fraud, and avoids dispensing an incorrect dosage.
Question 4
Your supervisor instructs you to bypass the verification process and to adjust or
add risk diagnosis codes for certain individuals. What should you do?
A) Do what your supervisor asked and adjust or add risk diagnosis codes
B) Report the incident to the compliance department
C) Discuss your concerns with your immediate supervisor
D) Call law enforcement
Correct Answer: B
Rationale: This request is unethical and potentially illegal. Bypassing established
processes can lead to false claims. Reporting through the appropriate compliance
channel (compliance hotline or other mechanism) is the correct and required
action.
,Question 5
You oversee paying claims submitted by providers. You notice a diagnostic
provider's claims for a certain procedure far exceed any other provider you
reviewed. What should you do?
A) Call the provider and request additional information
B) Consult with your supervisor or contact the compliance department
C) Reject the claims
D) Pay the claims
Correct Answer: B
Rationale: Irregular patterns in claims should be escalated. Consulting a supervisor
or compliance team initiates proper investigation into potential fraud, waste, or
abuse before any payment decision is made.
Question 6
You are performing a regular inventory of controlled substances and discover a
minor inventory discrepancy. What should you do?
A) Call local law enforcement
B) Perform another review
C) Contact your compliance department
D) Discuss your concerns with your supervisor
E) Follow your pharmacy's procedures
Correct Answer: E
Rationale: Even minor discrepancies involving controlled substances must be
documented and reported according to your pharmacy's internal policies and any
applicable regulatory requirements.
Question 7
Ways to report compliance issues/potential fraud, waste, and abuse (FWA)/HIPAA
include:
A) Telephone hotlines/Report via website
B) In-person reporting to the compliance department/your supervisor
C) Call 1-800-Medicare
D) USPS Mail/Fax
E) A, B, and D
Correct Answer: E
, Rationale: Multiple reporting channels exist for compliance issues. Anonymous
hotlines, internal reporting to supervisors or compliance departments, and written
communication via mail or fax are all acceptable methods.
Question 8
Any person who knowingly submits false claims to the Government is liable for
five times the Government's damages caused by the violator plus a penalty.
A) True
B) False
Correct Answer: B
Rationale: Under the False Claims Act, a person who knowingly submits false
claims is liable for three times (not five times) the Government's damages, plus a
penalty.
Question 9
Bribes or kickbacks of any kind for services that are paid under a Federal health
care program (which includes Medicare) constitute fraud by the person making as
well as the person receiving them.
A) True
B) False
Correct Answer: A
Rationale: The Anti-Kickback Statute prohibits offering, paying, soliciting, or
receiving remuneration to induce referrals for items or services covered by federal
healthcare programs. Both the giver and receiver are considered to have committed
fraud.
Question 10
Waste includes any misuse of resources, such as the overuse of services or other
practices that, directly or indirectly, result in unnecessary costs to the Medicare
Program.
A) True
B) False
Correct Answer: A
Rationale: Waste involves the overuse of services or other practices that result in
unnecessary costs to the Medicare Program. Unlike fraud, waste does not involve
intentional deception for financial gain.
CORRECT ANSWERS WITH RATIONALE
ALREADY GRADED A+
The AHIP Fraud, Waste, and Abuse (FWA) Exam is a critical component of
Medicare certification required for agents and brokers selling Medicare
Advantage and Part D plans. This comprehensive exam covers the
identification, prevention, and reporting of fraudulent activities within federal
healthcare programs. Key topics include the distinctions between fraud
(intentional deception), abuse (improper practices without intent), and waste
(unnecessary costs). The exam also addresses the False Claims Act, Anti-
Kickback Statute, HIPAA privacy requirements, and Section 1557
nondiscrimination provisions. Candidates must achieve a 90% passing score
within three attempts. Successful completion demonstrates understanding of
compliance obligations, ethical standards, and the importance of protecting
Medicare program integrity and beneficiary rights.
Question 1
Which of the following requires intent to obtain payment and the knowledge that
the actions are wrong?
A) Waste
B) Abuse
C) Fraud
D) Negligence
Correct Answer: C
Rationale: Fraud requires intent to obtain payment and the knowledge that the
actions are wrong. It is distinguished from abuse and waste by the intentional
deception for financial gain.
Question 2
,Which of the following is NOT a potential penalty for a violation of a law or
regulation prohibiting Fraud, Waste, and Abuse (FWA)?
A) Civil Monetary Penalties
B) Imprisonment
C) Exclusion from participation in all Federal health care programs
D) Deportation
Correct Answer: D
Rationale: While FWA violations can result in fines, imprisonment, and program
exclusion, deportation is not a standard penalty unless other immigration-related
offenses are involved.
Question 3
A person drops off a prescription for a controlled substance with a quantity of 160.
This beneficiary normally receives a quantity of 60. You have concerns about
possible forgery. What is your next step?
A) Fill the prescription for 160
B) Fill the prescription for 60
C) Call the prescriber to verify the quantity
D) Call the Sponsor's compliance department
E) Call law enforcement
Correct Answer: C
Rationale: Verification of suspicious prescriptions should begin with the
prescriber. Calling the prescriber to verify the quantity ensures patient safety,
prevents potential fraud, and avoids dispensing an incorrect dosage.
Question 4
Your supervisor instructs you to bypass the verification process and to adjust or
add risk diagnosis codes for certain individuals. What should you do?
A) Do what your supervisor asked and adjust or add risk diagnosis codes
B) Report the incident to the compliance department
C) Discuss your concerns with your immediate supervisor
D) Call law enforcement
Correct Answer: B
Rationale: This request is unethical and potentially illegal. Bypassing established
processes can lead to false claims. Reporting through the appropriate compliance
channel (compliance hotline or other mechanism) is the correct and required
action.
,Question 5
You oversee paying claims submitted by providers. You notice a diagnostic
provider's claims for a certain procedure far exceed any other provider you
reviewed. What should you do?
A) Call the provider and request additional information
B) Consult with your supervisor or contact the compliance department
C) Reject the claims
D) Pay the claims
Correct Answer: B
Rationale: Irregular patterns in claims should be escalated. Consulting a supervisor
or compliance team initiates proper investigation into potential fraud, waste, or
abuse before any payment decision is made.
Question 6
You are performing a regular inventory of controlled substances and discover a
minor inventory discrepancy. What should you do?
A) Call local law enforcement
B) Perform another review
C) Contact your compliance department
D) Discuss your concerns with your supervisor
E) Follow your pharmacy's procedures
Correct Answer: E
Rationale: Even minor discrepancies involving controlled substances must be
documented and reported according to your pharmacy's internal policies and any
applicable regulatory requirements.
Question 7
Ways to report compliance issues/potential fraud, waste, and abuse (FWA)/HIPAA
include:
A) Telephone hotlines/Report via website
B) In-person reporting to the compliance department/your supervisor
C) Call 1-800-Medicare
D) USPS Mail/Fax
E) A, B, and D
Correct Answer: E
, Rationale: Multiple reporting channels exist for compliance issues. Anonymous
hotlines, internal reporting to supervisors or compliance departments, and written
communication via mail or fax are all acceptable methods.
Question 8
Any person who knowingly submits false claims to the Government is liable for
five times the Government's damages caused by the violator plus a penalty.
A) True
B) False
Correct Answer: B
Rationale: Under the False Claims Act, a person who knowingly submits false
claims is liable for three times (not five times) the Government's damages, plus a
penalty.
Question 9
Bribes or kickbacks of any kind for services that are paid under a Federal health
care program (which includes Medicare) constitute fraud by the person making as
well as the person receiving them.
A) True
B) False
Correct Answer: A
Rationale: The Anti-Kickback Statute prohibits offering, paying, soliciting, or
receiving remuneration to induce referrals for items or services covered by federal
healthcare programs. Both the giver and receiver are considered to have committed
fraud.
Question 10
Waste includes any misuse of resources, such as the overuse of services or other
practices that, directly or indirectly, result in unnecessary costs to the Medicare
Program.
A) True
B) False
Correct Answer: A
Rationale: Waste involves the overuse of services or other practices that result in
unnecessary costs to the Medicare Program. Unlike fraud, waste does not involve
intentional deception for financial gain.
