2025 AHIP - Fraud, Waste, and Abuse Latest Update 2025-2026 Exam Questions with 100% Verified Correct Answers Guaranteed A+
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 ANSWER: Call
the prescriber to verify the quantity
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 ANSWER: True
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
ANSWER: False
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 ANSWER: True
Once a corrective action plan is started, the corrective action plan must be monitored
annually to ensure they are effective. - CORRECT ANSWER: False
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 Civil False Claims Act, the Anti-Kickback Statute, and the Criminal Health Care Fraud Statute. -
CORRECT ANSWER: True
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 ANSWER: True
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