Exam (elaborations)
2025 AHIP - Fraud, Waste, and Abuse QUESTIONS AND ANSWERS (2025/2026) (VERIFIED ANSWERS)
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2025 AHIP - Fraud, Waste, and Abuse QUESTIONS AND ANSWERS (2025/2026) (VERIFIED ANSWERS)
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2025 AHIP - Fraud, Waste, and AbuseWhich of the following calls for intent to achieve price and the expertise the movements are
wrong? - ANSFraud
Your activity is to publish a hazard prognosis to the Centers for Medicare & Medicaid
Services (CMS) for the reason of price. As part of this job, you use a system to confirm the
data is accurate. Your on the spot supervisor tells you to ignore the Sponsor's system and to
adjust or add chance prognosis codes for sure individuals. What ought to you do? -
ANSReport the incident to the compliance branch (thru compliance hotline or different
mechanism)
Which of the following is NOT potentially a penalty for violation of a law or regulation
prohibiting fraud, waste, and abuse (FWA)? - ANSDeportation
You are appearing a everyday inventory of the controlled substances within the pharmacy.
You discover a minor inventory discrepancy. What need to you do? - ANSFollow your
pharmacy's techniques.
A character drops off a prescription for a beneficiary who is a "everyday" customer. The
prescription is for a managed substance with a amount of a hundred and sixty. This
beneficiary normally receives a amount of 60, no longer 160. You assessment the
prescription and feature issues about feasible forgery. What is your next step? - ANSCall the
prescriber to verify the quantity
You are in price of paying claims submitted through carriers. You observe a certain
diagnostic issuer ("Doe Diagnostics") asked a good sized fee for a massive affected person
organization. Many of these claims are for a certain process. You review the same form of
system for other diagnostic companies and recognise Doe Diagnostics' claims a long way
exceed some other company you reviewed. What ought to you do? - ANSConsult with your
instantaneous supervisor for next steps or contact the compliance department (thru
compliance hotline, Special Investigations Unit [SIU], or other mechanism)
Bribes or kickbacks of any type for services that are paid beneath a Federal health care
program (which incorporates Medicare) constitute fraud through the character making as
well as the character receiving them. - ANSTrue
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. - ANSTrue
You can assist prevent fraud, waste, and abuse (FWA) through doing all the following:
Look for suspicious hobby
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