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2024 AHIP FWA EXAM WITH CORRECT ANSWERS
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2024 AHIP FWA EXAM WITH CORRECT ANSWERS
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2024 AHIP FWA EXAM WITHCORRECT ANSWERS
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 cover if the appropriate criteria are met? What could you tell
her? - CORRECT-ANSWERSOriginal Medicare covers ambulance services.
Which of the following requires intent to obtain payment and the knowledge
the actions are wrong? - CORRECT-ANSWERSFraud
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 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 Doe Diagnostics' claims far exceed any
other provider you reviewed. What should you do? - CORRECT-
ANSWERSConsult with your immediate supervisor for next steps or contact
the compliance department (via compliance hotline, Special Investigations
Unit [SIU], or other mechanism)
A person drops 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? - CORRECT-ANSWERSCall the prescriber to verify the quantity
Which of the following is NOT potentially a penalty for violation of a law or
regulation prohibiting fraud, waste, and abuse (FWA)? - CORRECT-
ANSWERSDeportation
Any person who knowingly submits false claims to the Government is liable
for five times the Government's damages caused by the violator plus a
penalty. - CORRECT-ANSWERSFalse (it's 3 times)
What are some of the penalties for violating fraud, waste, and abuse (FWA)
laws? - CORRECT-ANSWERSAll of the above
Ways to report potential fraud, waste, and abuse (FWA) include: - CORRECT-
ANSWERSAll of the above
,Once a corrective action plan is started, the corrective action plan must be
monitored annually to ensure they are effective. - CORRECT-ANSWERSFalse
Abuse involves payment for items or services when there is no legal
entitlement to that payment and the provider has not knowingly or
intentionally misrepresented facts to obtain payment. - CORRECT-
ANSWERSTrue
Waste includes any misuse of resources, such as the overuse of services or
other practices that directly or indirectly result in unnecessary costs to the
Medicare Program. - CORRECT-ANSWERSTrue
These are examples of issues that should be reported to a Compliance
Department: suspected fraud, waste, and abuse (FWA); potential health
privacy violation, unethical behavior, and employee misconduct. - CORRECT-
ANSWERSTrue
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-
ANSWERSTrue
You can help prevent fraud, waste, and abuse (FWA) by doing all the
following:
Look for suspicious activity
Conduct yourself in an ethical manner
Ensure accurate and timely data and billing
Ensure you coordinate with other payers
Keep up to date with FWA policies and procedures, standards of conduct,
laws, regulations, and the Centers for Medicare & Medicaid Services (CMS)
guidance
Verify all information provided to you - CORRECT-ANSWERSTrue
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 False Claims Act the Anti-Kickback Statute, and the Health Care
Fraud Statute. - CORRECT-ANSWERSFalse
You work for a Sponsor. Last month, while reviewing a Centers for Medicare
& Medicaid Services (CMS) monthly report, you identified multiple individuals
not enrolled in the plan but for whom the Sponsor is paid. You spoke to your
supervisor who said don't worry about it. This month, you identify the same
enrollees on the report again. What should you do? - CORRECT-
ANSWERSAlthough you know about the Sponsor's non-retaliation policy, you
are still nervous about reporting—to be safe, you submit a report through
your compliance department's anonymous tip line to avoid identification
, A sales agent, employed by the Sponsor's first-tier, downstream, or related
entity (FDR), submitted an application for processing and requested two
things: 1) to back-date the enrollment date by one month, and 2) to waive all
monthly premiums for the beneficiary. What should you do? - CORRECT-
ANSWERSProcess the application properly (without the requested revisions)
—inform your supervisor and the compliance officer about the sales agent's
request
You discover an unattended email address or fax machine in your office
receiving beneficiary appeals requests. You suspect no one is processing the
appeals. What should you do? - CORRECT-ANSWERSContact your compliance
department (via compliance hotline 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?
- CORRECT-ANSWERSFollow your pharmacy's procedures
What is the policy of non-retaliation? - CORRECT-ANSWERSProtects
employees, who in good faith report suspected non-compliance
Standards of Conduct are the same for every Medicare Parts C and D
sponsor. - CORRECT-ANSWERSFalse
At a minimum, an effective compliance program includes four core
requirements. - CORRECT-ANSWERSFalse
Correcting non-compliance________ - CORRECT-ANSWERSProtects enrollees,
avoids recurrence of same non-compliance, and promotes efficiency
Medicare Parts C and D sponsors are not required to have a compliance
program. - CORRECT-ANSWERSFalse
Compliance is the responsibility of the Compliance Officer, Compliance
Committee, and Upper Management only. - CORRECT-ANSWERSFalse
Mr. Singh would like drug coverage but does not want to be enrolled in a
Medicare Advantage plan. What should you tell him? - CORRECT-
ANSWERSMr. Singh can enroll in a stand-alone prescription drug plan and
continue to be covered for Part A and Part B services through Original Fee-
for-Service Medicare.
Mrs. Shields is covered by Original Medicare. She sustained a hip fracture
and is being successfully treated for that condition. However, she and her
physicians feel that after her lengthy hospital stay she will need a month or
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