Which of the following requires intent to obtain payment and the knowledge that thWhich of the following requires intent to obtain payment and the knowledge that the actions are wrong? - CORRECT ANSWER Fraud
Which of the following is not potentially a penalty for violation of the law or r...
AHIP FRAUD WASTE & ABUSE QUESTIONS WITH
COMPLETE SOLUTIONS GRADED A+
Which of the following requires intent to obtain payment and the knowledge that the
actions are wrong? - CORRECT ANSWER Fraud
Which of the following is not potentially a penalty for violation of the law or regulation
prohibiting fraud, waste and abuse (fwa)? - CORRECT ANSWER Deportation
A person comes into 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 the possible forgery. What is your next step? - CORRECT
ANSWER Call the prescriber to verify the quantity
Your job is to submit 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
sponsors process and to adjust/add risk diagnosis codes for certain individuals. What
should you do? - CORRECT 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 certain procedure. You review the
same type of procedure for other diagnostic providers and realize that doe diagnostics'
claim far exceed any other provider that you reviewed. What should you do? -
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller ACELEARNERS. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $15.49. You're not tied to anything after your purchase.
