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AHIP other questions and answers graded A+ by experts 2024/2025
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AHIP other questions and answers graded A+ by experts 2024/2025
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AHIP otherWhich of the following requires intent to obtain payment and the knowledge that the actions
are wrong? - ANSFraud
Which of the following is NOT potentially a penalty for violation of a law or regulation
prohibiting Fraud, Waste, and Abuse (FWA)? - ANSDeportation
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? - ANSCall 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? - ANSReport
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 that Doe Diagnostics' claims far exceed
any other provider that you reviewed. What should you do? - ANSConsult with your
immediate supervisor for next steps or contact the compliance department (via compliance
hotline, 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? - ANSFollow your pharmacy's
procedures
Compliance is the responsibility of the Compliance Officer, Compliance Committee, and
Upper Management only. - ANSFalse
Ways to report a compliance issue include: - ANSAll of the above
What is the policy of non-retaliation? - ANSProtects employees who, in good faith, report
suspected non-compliance
These are examples of issues that can be reported to a Compliance Department: suspected
Fraud, Waste, and Abuse (FWA); potential health privacy violation, and unethical
behavior/employee misconduct. - ANSTrue
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