AHFI EXAM QUESTIONS WITH 100%
COMPLETE SOLUTIONS
Anti-Kickback Statute (42 US SS 1320a-7b (b) prohibitions - correct answer ✔✔ Prohibits
offering, paying, soliciting or reviving anything of value to induce or reward referrals or generate
Federal health care program business
Anti-Kickback Statute (42 US SS 1320a-7b (b) referrals - correct answer ✔✔ Referrals from
anyone
Anti-Kickback Statute (42 US SS 1320a-7b (b) - correct answer ✔✔ Any items or services
Anti-Kickback Statute (42 US SS 1320a-7b (b) (Intent) - correct answer ✔✔ Intent MUST be
proven (knowing and willful)
Anti-Kickback Statute (42 US SS 1320a-7b (b) Criminal penalties - correct answer ✔✔ Fines up to
$25,000/violation
Up to a 5-yr prison term/violation
Anti-Kickback Statute (42 US SS 1320a-7b (b) (Civil/administrative) - correct answer ✔✔ False
Claims act liability
Civil monetary penalties and program exclusions
Potential $50,000 CMP/violation
,Civil assessment of up to 3x amount of kickback
Anti-Kickback Statute (42 US SS 1320a-7b (b) Exceptions - correct answer ✔✔ Voluntary safe
harbors
Anti-Kickback Statute (42 US SS 1320a-7b (b) - what it applies to... - correct answer ✔✔ All
Federal Health Care Programs
The Stark Law (42 US SS 139nn) Prohibition - correct answer ✔✔ Prohibits a physician from
referring Medicare patients for designated health services to an entity with which the physician
(or immediate family member) has a financial relationship, unless an exception applies)
Prohibits the designated health services entity from submitting claims to Medicare for those
services resulting from a prohibited referral
The Stark Law (42 US SS 139nn) Referrals - correct answer ✔✔ Referrals from a physician
The Stark Law (42 US SS 139nn) (Items/Services) - correct answer ✔✔ Designated health
services
The Stark Law (42 US SS 139nn) (Intent) - correct answer ✔✔ No intent standard for
overpayment (strict liability)
Intent required for civil monetary penalties for knowing violations
The Stark Law (42 US SS 139nn) (Civil Penalties) only - correct answer ✔✔ Overpayment/refund
obligation
False Claims Act liability
, Civil monetary penalties and program exclusion for knowing violations
Potential $15,000 CMP for each service
Civil assessment of up to 3x the amount claimed.
The Stark Law (42 US SS 139nn) (Exceptions) - correct answer ✔✔ Mandatory exceptions
The Stark Law (42 US SS 139nn) applies to - correct answer ✔✔ Medicare and Medicaid
(No commercial or tricare)
MACs: - correct answer ✔✔ Medicare Administrative Contractors
They analyze claims to determine provider compliance with Medicare coverage, coding, and
billing rules and take appropriate corrective action when providers are found to be non-
compliant.
The goal of Mac administrative actions - correct answer ✔✔ To correct the behavior in need of
change and prevent future inappropriate billing
The priority of MACs - correct answer ✔✔ To minimize potential future losses to the Medicare
Trust Fund through targeted claims review while using resource efficiently and treating
providers and beneficiaries fairly.
COMPLETE SOLUTIONS
Anti-Kickback Statute (42 US SS 1320a-7b (b) prohibitions - correct answer ✔✔ Prohibits
offering, paying, soliciting or reviving anything of value to induce or reward referrals or generate
Federal health care program business
Anti-Kickback Statute (42 US SS 1320a-7b (b) referrals - correct answer ✔✔ Referrals from
anyone
Anti-Kickback Statute (42 US SS 1320a-7b (b) - correct answer ✔✔ Any items or services
Anti-Kickback Statute (42 US SS 1320a-7b (b) (Intent) - correct answer ✔✔ Intent MUST be
proven (knowing and willful)
Anti-Kickback Statute (42 US SS 1320a-7b (b) Criminal penalties - correct answer ✔✔ Fines up to
$25,000/violation
Up to a 5-yr prison term/violation
Anti-Kickback Statute (42 US SS 1320a-7b (b) (Civil/administrative) - correct answer ✔✔ False
Claims act liability
Civil monetary penalties and program exclusions
Potential $50,000 CMP/violation
,Civil assessment of up to 3x amount of kickback
Anti-Kickback Statute (42 US SS 1320a-7b (b) Exceptions - correct answer ✔✔ Voluntary safe
harbors
Anti-Kickback Statute (42 US SS 1320a-7b (b) - what it applies to... - correct answer ✔✔ All
Federal Health Care Programs
The Stark Law (42 US SS 139nn) Prohibition - correct answer ✔✔ Prohibits a physician from
referring Medicare patients for designated health services to an entity with which the physician
(or immediate family member) has a financial relationship, unless an exception applies)
Prohibits the designated health services entity from submitting claims to Medicare for those
services resulting from a prohibited referral
The Stark Law (42 US SS 139nn) Referrals - correct answer ✔✔ Referrals from a physician
The Stark Law (42 US SS 139nn) (Items/Services) - correct answer ✔✔ Designated health
services
The Stark Law (42 US SS 139nn) (Intent) - correct answer ✔✔ No intent standard for
overpayment (strict liability)
Intent required for civil monetary penalties for knowing violations
The Stark Law (42 US SS 139nn) (Civil Penalties) only - correct answer ✔✔ Overpayment/refund
obligation
False Claims Act liability
, Civil monetary penalties and program exclusion for knowing violations
Potential $15,000 CMP for each service
Civil assessment of up to 3x the amount claimed.
The Stark Law (42 US SS 139nn) (Exceptions) - correct answer ✔✔ Mandatory exceptions
The Stark Law (42 US SS 139nn) applies to - correct answer ✔✔ Medicare and Medicaid
(No commercial or tricare)
MACs: - correct answer ✔✔ Medicare Administrative Contractors
They analyze claims to determine provider compliance with Medicare coverage, coding, and
billing rules and take appropriate corrective action when providers are found to be non-
compliant.
The goal of Mac administrative actions - correct answer ✔✔ To correct the behavior in need of
change and prevent future inappropriate billing
The priority of MACs - correct answer ✔✔ To minimize potential future losses to the Medicare
Trust Fund through targeted claims review while using resource efficiently and treating
providers and beneficiaries fairly.
