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AHIP - Fraud, Waste, and Abuse Exam: Final Year 2024/25, Exams of Nursing

A series of multiple-choice questions and answers related to ahip (american health information management association) standards for fraud, waste, and abuse in healthcare. It covers topics such as identifying suspicious activity, reporting potential violations, and understanding the legal implications of fwa. Designed to help students prepare for an exam on this subject.

Typology: Exams

2024/2025

Available from 11/16/2024

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2025 AHIP - Fraud, Waste, and Abuse
Exam Final Year 2024/25
1. 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? -
Correct Ans: ✔✔Consult with your immediate supervisor for next
steps or contact the compliance department (via compliance hotline,
Special Investigations Unit [SIU], or other mechanism)
2. 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. -
Correct Ans: ✔✔True
3. 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. -
Correct Ans: ✔✔True
4. You can help prevent fraud, waste, and abuse (FWA) by doing all the
following:
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2025 AHIP - Fraud, Waste, and Abuse

Exam Final Year 2024/

  1. 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? - Correct Ans: ✔✔Consult with your immediate supervisor for next steps or contact the compliance department (via compliance hotline, Special Investigations Unit [SIU], or other mechanism)
  2. 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. - Correct Ans: ✔✔True
  3. 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. - Correct Ans: ✔✔True
  4. You can help prevent fraud, waste, and abuse (FWA) by doing all the following:

 Look for suspicious activity  Conduct yourself in an ethical manner  Ensure accurate and timely data and billing  Ensure you coordinate with other payers Keep up to date with FWA policies and procedures, standards of conduct, laws, regulations, and the Centers for Medicare & Medicaid Services (CMS) guidance

  1. Verify all information provided to you - Correct Ans: ✔✔True
  2. What are some of the penalties for violating fraud, waste, and abuse (FWA) laws? - Correct Ans: ✔✔All of the above
  3. 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. - Correct Ans: ✔✔True
  4. 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. - Correct Ans: ✔✔True

compliance department (via compliance hotline or other mechanism)

  1. Which of the following is NOT potentially a penalty for violation of a law or regulation prohibiting fraud, waste, and abuse (FWA)? - Correct Ans: ✔✔Deportation
  2. You are performing a regular inventory of the controlled substances in the pharmacy. You discover a minor inventory discrepancy. What should you do? - Correct Ans: ✔✔Follow your pharmacy's procedures.
  3. 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? - Correct Ans: ✔✔Call the prescriber to verify the quantity