AHIP FWA EXAM(ACTUAL
EXAM)QUESTIONS WITH VERY
ELABORATED ANSWERS CORRECTRY WELL
ORGANIZED LATEST ALREADY GRADED
A+/AHIP FRAUD,WASTE AND ABUSE EXAM
LATEST GRADED A+ 2024 – 2025
You work for Caring Health, a Medicare Advantage (MA) plan sponsor. Recently,
Mrs. Garcia has completed an enrollment application for a plan offered by Caring
Health, which is waiting for a reply from CMS indicating whether or not Mrs.
Garcia's enrollment has been accepted. Once CMS replies, how long does Caring
Health have to notify Mrs. Garcia that her enrollment has been accepted and in
what format? Mr. Rockwell, age 67, is enrolled in Medicare Part A, but because he
continues to work and is covered by an employer health plan, he has not enrolled
in Part B or Part D. He receives a notice on June 1 that his employer is cutting back
on prescription drug benefits and that as of July 1 his coverage will no longer be
creditable. He has come to you for advice. What advice would you give Mr.
Rockwell about special election periods (SEPs)? - ANSWERS-The plan has 10
calendar days to notify Mrs. Garcia in writing.
Ms. Stuart has heard about a special needs plan (SNP) that one of her friends is
enrolled in and is interested in that product. She wants to be sure she also has
,coverage for prescription drugs. Would she be able to obtain drug coverage if she
enrolled in the SNP? - ANSWERS-Maybe. Some SNPs offer Part D coverage for
prescription drugs and some do not.
Mr. Lopez, who is fairly well-off financially, would like to enroll in a Medicare
prescription drug plan you represent and simply give you a check to cover his
premiums for the entire year. What should you tell him? - ANSWERS-Enrollees
should pay using automatic withdrawal from a bank account or credit or debit
card, direct monthly billing from the plan, or deductions from their Social Security
check.
Since 2004 Ms. Eisenberg has had a Medigap plan that provides some drug
coverage. She has recently received a letter from her Medigap carrier informing
her that her drug coverage is not "creditable." She wants to know what this
means. What should you tell her? - ANSWERS-The letter is to inform her that the
drug coverage offered through her Medigap plan does not offer drug coverage
that is at least comparable to that provided under the Medicare Part D
prescription drug program. If she does not have such creditable coverage during
periods when she is first eligible for the Part D program, she will face a premium
penalty if she enrolls in a Part D plan at a later date.
Which of the following is/are most likely to be characterized as an involuntary
disenrollment from a Medicare Advantage (MA) plan?
I. The enrollee dies.
II. An individual materially misrepresents information to a PDP sponsor regarding
reimbursement for third-party coverage.
III. It is determined that the member is not lawfully present in the United States.
,IV. The member enrolls in another plan during the Annual Open Enrollment
period. - ANSWERS-I, II, and III only
Madeline Martinez was widowed several years ago. Her husband worked for
many years and contributed into the Medicare system. He also left a substantial
estate which provides Madeline with an annual income of approximately
$130,000. Madeline, who has only worked part-time for the last three years, will
soon turn age 65 and hopes to enroll in Original Medicare. She comes to you for
advice. What should you tell her? - ANSWERS-You should tell Madeline that she
will be able to enroll in Medicare Part A without paying monthly premiums due to
her husband's long work record and participation in the Medicare system. You
should also tell Madeline that she will pay Part B premiums at more than the
standard lowest rate but less than the highest rate due her substantial income.
Mrs. West wears glasses and dentures and has enjoyed considerable pain relief
from arthritis through massage therapy. She is concerned about whether or not
Medicare will cover these items and services. What should you tell her? -
ANSWERS-Medicare does not cover massage therapy, or, in general, glasses or
dentures.
Mrs. Quinn recently turned 66 and decided after many years of work to begin
receiving Social Security benefits. Shortly thereafter Mrs. Quinn received a letter
informing her that she has been automatically enrolled in Medicare Part B. She
wants to understand what this means. What should you tell Mrs. Quinn? -
ANSWERS-Part B primarily covers physician services. She will be paying a monthly
premium and, with the exception of many preventive and screening tests,
generally will have 20% coinsurance for these services, in addition to an annual
deductible.
, Mrs. Geisler's neighbor told her she should look at her Part D options during the
annual Medicare enrollment period because features of Part D might have
changed. Mrs. Geisler can't remember what Part D is so she called you to ask
what her neighbor was talking about. What could you tell her? - ANSWERS-Part D
covers prescription drugs and she should look at her premiums, formulary, and
cost-sharing among other factors to see if they have changed.
Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has recently
reviewed her Medicare Summary Notice (MSN) and disagrees with a
determination that partially denied one of her claims for services. What advice
would you give her? - ANSWERS-Mrs. Duarte should file an appeal of this initial
determination within 120 days of the date she received the MSN in the mail.
Mr. Rainey is experiencing paranoid delusions and his physician feels that he
should be hospitalized. What should you tell Mr. Rainey (or his representative)
about the length of an inpatient psychiatric hospital stay that Medicare will
cover? - ANSWERS-Medicare will cover a total of 190 days of inpatient psychiatric
care during Mr. Rainey's entire lifetime.
Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you
tell Mrs. Park that might be of assistance? - ANSWERS-She should contact her
state Medicaid agency to see if she qualifies for one of several programs that can
help with Medicare costs for which she is responsible.
Mrs. Turner is comparing her employer's retiree insurance to Original Medicare
and would like to know which of the following services Original Medicare will
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