AHIP FRAUD WASTE & ABUSE QUESTIONS WITH
COMPLETE SOLUTIONS GRADED A+
Which of the following requires intent to obtain payment and the knowledge that the
actions are wrong? - CORRECT ANSWER Fraud
Which of the following is not potentially a penalty for violation of the law or regulation
prohibiting fraud, waste and abuse (fwa)? - CORRECT ANSWER Deportation
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? - CORRECT
ANSWER Call the prescriber to verify the quantity
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? - CORRECT 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 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? -
COMPLETE SOLUTIONS GRADED A+
Which of the following requires intent to obtain payment and the knowledge that the
actions are wrong? - CORRECT ANSWER Fraud
Which of the following is not potentially a penalty for violation of the law or regulation
prohibiting fraud, waste and abuse (fwa)? - CORRECT ANSWER Deportation
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? - CORRECT
ANSWER Call the prescriber to verify the quantity
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? - CORRECT 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 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? -
