AHIP Fraud, Waste, and Abuse (FWA) Prevention 2

Question 1

What is 'waste' in the context of Medicare FWA?

Accepted Answer

Overutilization or misuse of resources without intent to defraud

Answer

Waste refers to overutilization, misuse, or inefficient use of resources that results in unnecessary program costs, without intentional deception.

Question 2

A Medicare beneficiary who knowingly lets someone else use their Medicare card commits:

Accepted Answer

Fraud

Answer

Allowing another person to use your Medicare benefits is Medicare fraud because it involves deliberate misrepresentation to obtain benefits.

Question 3

What is the OIG Exclusion List?

Accepted Answer

A list of individuals and entities excluded from participating in federal healthcare programs due to misconduct

Answer

The OIG Exclusion List identifies individuals and entities barred from participating in Medicare, Medicaid, and other federal healthcare programs.

Question 4

Under HIPAA, individually identifiable health information (PHI) may NOT be disclosed without patient authorization EXCEPT:

Accepted Answer

For treatment, payment, or healthcare operations

Answer

HIPAA permits disclosure of PHI without authorization for treatment, payment, and healthcare operations (TPO).

Question 5

Which of the following is an example of 'abuse' rather than 'fraud'?

Accepted Answer

Routinely scheduling more follow-up visits than medically necessary without intent to defraud

Answer

Abuse involves practices inconsistent with sound medical, business, or fiscal practices that increase program costs, but without deliberate deceptive intent.

AHIP - America's Health Insurance Plans Practice Test

AHIP - America's Health Insurance Plans Practice Test

AHIP Fraud, Waste, and Abuse (FWA) Prevention 2