AHIP fraud waste

Which of the following requires intent to obtain payment and the knowledge that the actions are wrong? Fraud Which of the following is not potentially a penalty for violation of the law or regulation prohibiting fraud, waste and abuse (fwa)? 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? 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? Report the incident to the compliance department (via compliance hotline or other mechanism)