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AHIP Training Medicare Fraud, Waste,
And Abuse Training |High Quality
Questions And Comprehensive Answers
2026
Medicare plan means - correct-answer-A MA plan, MA-PD plan or PDP
The Scope of Healthcare FWA - correct-answer-**As a nation, we spend over $2.7
trillion on Healthcare every year, and it is estimated that tens of billions are lost
each year to FWA.
**One recent study estimated that fraud and abuse added as much as $98 billion
to annual spending on Medicare and Medicaid.
Combating FWA: A Health Plan Priority - correct-answer-**Medicare plans also
recognize the seriousness of FWA, which not only result in lost dollars but can
jeopardize the quality of healthcare received by plan enrollees.
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**Health plans seek your help in combating FWA and this training is designed to
help you recognize questionable activity and take steps to stop or prevent it.
The Human Cost of FWA: An example - correct-answer-**As mentioned, FWA is
not only costly, it can have serious implications for the health of Medicare plan
enrollees.
**Member has card stolen and used by someone else for Rx's and other medical
treatments; therefore member is unable to get her Rx's renewed. Member goes
w/o her meds and has a minor stroke. Now her health records are not accurate.
Example of Fraud Committed by a Pharmacist - correct-answer-When Pharmacist
James Wilson fills Rx's for pain relievers, he deliberately puts fewer pills in the
bottle than the prescribed number. His customers usually don't notice or think
they have miscounted. James keeps the extra pills and sells them to a local drug
dealer.
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Examples of Fraud by Agents and Brokers - correct-answer-**Agents and brokers
involved in the sale of Medicare plans can also commit fraud. Here are some
examples of actions dishonest agents might engage in to fraudulently earn sales
commission.
*An agent completes an application for a Part D plan for a Medicare beneficiary
w/o the beneficiaries knowledge.
*An agent visits a nursing home, copies down the names of Medicare
beneficiaries living there, and submits applications to a Medicare Part D plan in
their names.
*An agent offers a cash payment to a Medicare beneficiary to enroll in a
particular Part D plan.
*An agent misrepresents key information about benefits or cost sharing to
prospective enrollees in order to entice them to enroll.
Example of Fraud Committed by a Medicare Part D beneficiary - correct-answer-
Jacqueline Harris, a Medicare Part D enrollee, has a legitimate Rx form her doctor,
but she alters it from 60 to 160 pills and sell the surplus to people she knows.
AHIP Training Medicare Fraud, Waste,
And Abuse Training |High Quality
Questions And Comprehensive Answers
2026
Medicare plan means - correct-answer-A MA plan, MA-PD plan or PDP
The Scope of Healthcare FWA - correct-answer-**As a nation, we spend over $2.7
trillion on Healthcare every year, and it is estimated that tens of billions are lost
each year to FWA.
**One recent study estimated that fraud and abuse added as much as $98 billion
to annual spending on Medicare and Medicaid.
Combating FWA: A Health Plan Priority - correct-answer-**Medicare plans also
recognize the seriousness of FWA, which not only result in lost dollars but can
jeopardize the quality of healthcare received by plan enrollees.
,2|Page
**Health plans seek your help in combating FWA and this training is designed to
help you recognize questionable activity and take steps to stop or prevent it.
The Human Cost of FWA: An example - correct-answer-**As mentioned, FWA is
not only costly, it can have serious implications for the health of Medicare plan
enrollees.
**Member has card stolen and used by someone else for Rx's and other medical
treatments; therefore member is unable to get her Rx's renewed. Member goes
w/o her meds and has a minor stroke. Now her health records are not accurate.
Example of Fraud Committed by a Pharmacist - correct-answer-When Pharmacist
James Wilson fills Rx's for pain relievers, he deliberately puts fewer pills in the
bottle than the prescribed number. His customers usually don't notice or think
they have miscounted. James keeps the extra pills and sells them to a local drug
dealer.
, 3|Page
Examples of Fraud by Agents and Brokers - correct-answer-**Agents and brokers
involved in the sale of Medicare plans can also commit fraud. Here are some
examples of actions dishonest agents might engage in to fraudulently earn sales
commission.
*An agent completes an application for a Part D plan for a Medicare beneficiary
w/o the beneficiaries knowledge.
*An agent visits a nursing home, copies down the names of Medicare
beneficiaries living there, and submits applications to a Medicare Part D plan in
their names.
*An agent offers a cash payment to a Medicare beneficiary to enroll in a
particular Part D plan.
*An agent misrepresents key information about benefits or cost sharing to
prospective enrollees in order to entice them to enroll.
Example of Fraud Committed by a Medicare Part D beneficiary - correct-answer-
Jacqueline Harris, a Medicare Part D enrollee, has a legitimate Rx form her doctor,
but she alters it from 60 to 160 pills and sell the surplus to people she knows.
