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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:
