Ahip Fwa Exam | Questions & Answers (Rated 98%) | 2022/ 2023 Latest Update

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? {Ans: Consult with your immediate supervisor for the next steps or contact the compliance department (via compliance hotline, special investigation unit (siu), or other mechanism)}Which of the following requires intent to obtain payment and the knowledge that the actions are wrong? {Ans: Fraud}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? {Ans: Call the prescriber to verify the quantity}Which of the following is not potentially a penalty for violation of the law or regulation prohibiting fraud, waste and abuse (fwa)? {Ans: Deportation}You