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AHIP 2024 FRAUD Final Exam questions and answers 2015/2016
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AHIP 2024 FRAUD Final Exam1. Abuse involves payment for items or services when there is no legal entitlement to that
payment and the provider has not knowingly or
intentionally misrepresented facts to obtain payment. >ANS>True
2. Any person who knowingly submits false claims to the Government is liable for five times
the Government's damages caused by the
violator plus a penalty. >ANS>False
3. Bribes or kickbacks of any kind for services that are paid under a Federal health care
program (which includes Medicare) constitute fraud
by the person making as well as the person receiving them. >ANS>True
4. Once a corrective action plan is started, the corrective action plan must be monitored
annually to ensure they are effective. >ANS>False
5. Some of the laws governing Medicare Part C and D fraud, waste, and abuse (FWA)
include the Health Insurance Portability and
6. Accountability Act (HIPAA), the Civil False Claims Act, the Anti-Kickback Statute, and the
Criminal Health Care Fraud Statute. >ANS>True
7. These are examples of issues that should be reported to a Compliance Department:
suspected fraud, waste, and abuse (FWA); potential
8. health privacy violation, unethical behavior, and employee misconduct. >ANS>True
9. Waste includes any misuse of resources, such as the overuse of services or other
practices that directly or indirectly result in unnecessary
10. costs to the Medicare Program. >ANS>True
11. Ways to report potential fraud, waste, and abuse (FWA) include: >ANS>All of the above
12. What are some of the penalties for violating fraud, waste, and abuse (FWA) laws?
>ANS>All of the above
13. You can help prevent fraud, waste, and abuse (FWA) by doing all the following:
14. Look for suspicious activity
15. Conduct yourself in an ethical manner
16. Ensure accurate and timely data and billing
17. Ensure you coordinate with other payers
18. Keep up to date with FWA policies and procedures, standards of conduct, laws,
regulations, and the Centers for Medicare & Medicaid
19. Services (CMS) guidance
20. Verify all information provided to you >ANS>True
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