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AHIP other/16 QUESTIONS WITH COMPLETE SOLUTIONS
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AHIP other/16 QUESTIONS WITH COMPLETE SOLUTIONS
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AHIP other/16 QUESTIONS WITH COMPLETESOLUTIONS
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 a law or
regulation prohibiting Fraud, Waste, and Abuse (FWA)? - -Deportation
-A person comes to 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
possible forgery. What is your next step? - -Call the prescriber to verify the
quantity
-Your job is to submit a 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 Sponsor's 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
-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 a
certain procedure. You review the same type of procedure for other
diagnostic providers and realize that Doe Diagnostics' claims far exceed any
other provider that you reviewed. What should you do? - -Consult with your
immediate supervisor for next steps or contact the compliance department
(via compliance hotline, Special Investigations Unit (SIU), or other
mechanism)
-You are performing a regular inventory of the controlled substances in the
pharmacy. You discover a minor inventory discrepancy. What should you do?
- -Follow your pharmacy's procedures
-Compliance is the responsibility of the Compliance Officer, Compliance
Committee, and Upper Management only. - -False
-Ways to report a compliance issue include: - -All of the above
-What is the policy of non-retaliation? - -Protects employees who, in good
faith, report suspected non-compliance
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