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2025 AHIP - Fraud, Waste, and Abuse questions and answers 2015/2016 $7.99
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2025 AHIP - Fraud, Waste, and Abuse questions and answers 2015/2016
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2025 AHIP - Fraud, Waste, and Abuse questions and answers 2015/2016 best for exam revision and rated A with guaranteed excellence results

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  • October 22, 2024
  • 2
  • 2024/2025
  • Exam (elaborations)
  • Questions & answers

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2025 AHIP - Fraud, Waste, and Abuse

1. A person drops 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? >ANS>Call the prescriber to verify the quantity

2. 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

3. 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

4. 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

5. Once a corrective action plan is started, the corrective action plan must be monitored
annually to ensure they are effective. >ANS>False

6. Some of the laws governing Medicare Part C and D fraud, waste, and abuse (FWA)
include the Health Insurance Portability and 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 health privacy violation, unethical
behavior, and employee misconduct. >ANS>True

8. Waste includes any misuse of resources, such as the overuse of services or other
practices that directly or indirectly result in unnecessary costs to the Medicare Program.
>ANS>True

9. Ways to report potential fraud, waste, and abuse (FWA) include: >ANS>All of the above

10. What are some of the penalties for violating fraud, waste, and abuse (FWA) laws?
>ANS>All of the above

11. Which of the following is NOT potentially a penalty for violation of a law or regulation
prohibiting fraud, waste, and abuse (FWA)? >ANS>Deportation

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