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AHIP Final Review FWA 3 questions and answers 2015/2016
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AHIP 2024 Final Review FWA 31. 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. Which of the following is NOT potentially a penalty for violation of a law or regulation
prohibiting fraud, waste, and abuse (FWA)? >ANS>Deportation
3. Which of the following requires intent to obtain payment and the knowledge the actions
are wrong? >ANS>Fraud
4. You are in charge of paying claims submitted by providers. You notice a certain
diagnostic provider ("Doe Diagnostics") requested a
substantial payment for a large patient group. Many of these claims are for a certain
procedure. You review the same type of procedure
for other diagnostic providers and realize Doe Diagnostics' claims far exceed any other
provider you reviewed. What should you do? >ANS>Consult with your immediate
supervisor for next steps or contact the compliance department (via compliance hotline,
5. 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? >ANS>Follow your pharmacy's procedures.
6. 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 use a process to verify the data is accurate. Your immediate supervisor tells you
to ignore the Sponsor's process and to adjust or
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)
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