AHIP FWA EXAM | Questions & Answers (RATED 98%) | 2022/ 2023 Latest Update
Which of the following requires intent to obtain payment and the knowledge that the actions are wrong?
Which of the following is not potentially a penalty for violation of the law or regulation prohibiting fraud, waste and...
1). Which of the following requires intent to obtain payment and the knowledge that the actions
are wrong?
Ans: Fraud
2). Which of the following is not potentially a penalty for violation of the law or regulation
prohibiting fraud, waste and abuse (fwa)?
Ans: Deportation
3). 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?
Ans: Call the prescriber to verify the quantity
4). 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?
Ans: Report the incident to the compliance department (via compliance hotline or other
mechanism)
5). 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?
Ans: Consult with your immediate supervisor for the next steps or contact the
compliance department (via compliance hotline, special investigation unit (siu), or other
mechanism)
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