AHIP - QUESTIONS AND ANSWERS
Which of the following requires intent to obtain payment and the
knowledge that the actions are wrong? - answer ✔ ✔ Fraud
Which of the following is NOT potentially a penalty for violation of
a law or regulation prohibiting Fraud, Waste, and Abuse (FWA)? -
answer ✔ ✔ Deportation
A person comes to your pharmacy to drop 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? - answer ✔ ✔ Call the prescriber to verify the
quantity
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 verify, through a certain process, that the data is
accurate. Your immediate supervisor tells you to ignore the
Sponsor's process and to adjust/add risk diagnosis codes for
certain individuals. What should you do? - answer ✔ ✔ Report the
incident to the compliance department (via compliance hotline or
other mechanism
You are in charge of payment of claims submitted by providers.
You notice a certain diagnostic provider ("Doe Diagnostics")
requested a substantial payment for a large number of members.
Many of these claims are for a certain procedure. You review the
same type of procedure for other diagnostic providers and realize
