UHC ETHICS & COMPLIANCE EXAM QUESTIONS
COMPLETE WITH 100% VERIFIED ANSWERS
1 A UHC employee suspects a colleague is submitting false claims to Medicare
What is the first required action under UHC policy
A Confront the colleague directly
B Report through the UHC Ethics & Compliance Line or other authorized channel
C Wait for more evidence before acting
D Notify the Medicare Fraud Office directly
Correct Answer B
Rationale UHC policy mandates immediate reporting of suspected fraud or
misconduct through internal channels Ethics & Compliance Line manager
compliance officer Confrontation A is discouraged delaying C violates timely
reporting obligations external reporting D should not replace internal reporting
though it may be required by law
2 Under the UHC Code of Conduct which of the following is an acceptable gift to
give a government official
A A 50 restaurant gift card
B A pen with UHC logo valued at 5
C Tickets to a sports event worth 75
D A bottle of wine valued at 40
Correct Answer B
Rationale Nominal promotional items of minimal value under 10 15 are generally
permissible Anything over nominal value or that could appear to influence official
decisions is prohibited for government officials due to anti bribery laws such as
the federal Anti Kickback Statute and state ethics rules
3 A Medicare Advantage member complains that UHC denied a service she
believes should be covered She threatens to report UHC to CMS Which action is
,most appropriate
A Tell her that reporting will delay her appeal
B Ignore the threat and process the denial as usual
C Ensure she receives proper notice of appeal rights and assist with the appeal
process
D Offer her a gift card to withdraw the complaint
Correct Answer C
Rationale Members have the right to appeal denials and to file complaints with
CMS Threatening to report does not change UHCs obligation to provide proper
notices and appeal assistance Offering incentives D would be fraudulent and
ignoring B could violate CMS requirements
4 UHCs Conflict of Interest policy requires an employee to disclose which of the
following
A Ownership of less than 1 of a publicly traded health care company
B A spouse who works as a nurse at a hospital that is not contracted with UHC
C Serving on the board of a non profit that sells medical equipment to UHC
D Having a cousin who is a UHC employee in a different department
Correct Answer C
Rationale Serving on the board of a vendor that does business with UHC creates a
potential conflict requiring disclosure Ownership under 1 in a large public
company A is generally exempt B is not typically a conflict unless the spouse
influences contracting D is familial but not automatically a conflict unless
hierarchical or financial influence exists
5 Which law specifically prohibits offering any remuneration including kickbacks
or bribes to induce referrals of federal health care program business
A HIPAA Privacy Rule
B Stark Law
C Anti Kickback Statute
C False Claims Act
Correct Answer C Anti Kickback Statute
Rationale The federal Anti Kickback Statute 42 USC 1320a 7b makes it a felony to
knowingly offer pay solicit or receive remuneration to induce referrals for services
,paid by federal health care programs Stark Law B prohibits physician self referral
not kickbacks per se False Claims Act D addresses false billing HIPAA A addresses
privacy
6 A UHC claims processor accidentally deletes an appeal request from the
system and does not process it The member later discovers this and files a
complaint with CMS What is the best description of this conduct
A Fraud
B Waste
C Abuse
D Acceptable human error
Correct Answer C Abuse
Rationale Abuse involves actions that may be inconsistent with sound medical
business or fiscal practices but lack the intent to deceive or mislead needed for
fraud Fraud A requires knowing false representation Waste B is overutilization not
improper deletion of an appeal
7 Under UHC policy which of the following is considered protected activity under
the Code of Conduct
A Complaining to a coworker about a managers rudeness
B Refusing to commit an illegal act even if directed by a supervisor
C Posting negative comments about UHC on social media
D Quietly ignoring a violation to avoid conflict
Correct Answer B
Rationale Protected activity includes good faith reporting of misconduct or
refusing to follow illegal directives Social media posts C are generally not
protected unless whistleblowing rude comments A are not compliance related
ignoring D is the opposite of protected activity
8 A UHC sales agent tells a potential Medicare beneficiary You must buy this
plan today or you will lose your chance to enroll forever even though the
enrollment period is open for six more weeks This is an example of
A Permissible marketing
B Misleading or high pressure sales tactics
, C A correct statement of enrollment rules
D An acceptable way to close a sale
Correct Answer B
Rationale CMS marketing guidelines prohibit misleading statements creating false
urgency or pressuring beneficiaries Agents must provide accurate enrollment
period information
9 Which of the following is permitted under the UHC privacy policy regarding
protected health information PHI
A Sharing PHI with a spouse who calls to ask about a members diagnosis without
the members consent
B Leaving a detailed voicemail about a members lab results on an unsecured
answering machine
C Discussing a members PHI with another UHC employee who needs the
information to process an appeal
D Disposing of paper PHI in a regular trash bin
Correct Answer C
Rationale The minimum necessary standard and treatment payment operations
exceptions allow sharing PHI within UHC for legitimate business purposes without
patient authorization Spouse A requires authorization or the members presence
voicemail B requires reasonable safeguards trash D is impermissible proper
disposal requires shredding or locked bins
10 A manager asks an employee to backdate a prior authorization approval to
avoid an untimely determination penalty Which of the following is true
A The manager may be violating the False Claims Act if the backdated approval
leads to a false certification to CMS
B Backdating is acceptable if the original decision was clinically correct
C Only the manager faces liability the employee is protected
D This is a minor administrative error with no legal consequence
Correct Answer A
Rationale Backdating creates false records submitted to CMS potentially triggering
False Claims Act liability Both manager and employee B can face consequences no
C it is not minor D
COMPLETE WITH 100% VERIFIED ANSWERS
1 A UHC employee suspects a colleague is submitting false claims to Medicare
What is the first required action under UHC policy
A Confront the colleague directly
B Report through the UHC Ethics & Compliance Line or other authorized channel
C Wait for more evidence before acting
D Notify the Medicare Fraud Office directly
Correct Answer B
Rationale UHC policy mandates immediate reporting of suspected fraud or
misconduct through internal channels Ethics & Compliance Line manager
compliance officer Confrontation A is discouraged delaying C violates timely
reporting obligations external reporting D should not replace internal reporting
though it may be required by law
2 Under the UHC Code of Conduct which of the following is an acceptable gift to
give a government official
A A 50 restaurant gift card
B A pen with UHC logo valued at 5
C Tickets to a sports event worth 75
D A bottle of wine valued at 40
Correct Answer B
Rationale Nominal promotional items of minimal value under 10 15 are generally
permissible Anything over nominal value or that could appear to influence official
decisions is prohibited for government officials due to anti bribery laws such as
the federal Anti Kickback Statute and state ethics rules
3 A Medicare Advantage member complains that UHC denied a service she
believes should be covered She threatens to report UHC to CMS Which action is
,most appropriate
A Tell her that reporting will delay her appeal
B Ignore the threat and process the denial as usual
C Ensure she receives proper notice of appeal rights and assist with the appeal
process
D Offer her a gift card to withdraw the complaint
Correct Answer C
Rationale Members have the right to appeal denials and to file complaints with
CMS Threatening to report does not change UHCs obligation to provide proper
notices and appeal assistance Offering incentives D would be fraudulent and
ignoring B could violate CMS requirements
4 UHCs Conflict of Interest policy requires an employee to disclose which of the
following
A Ownership of less than 1 of a publicly traded health care company
B A spouse who works as a nurse at a hospital that is not contracted with UHC
C Serving on the board of a non profit that sells medical equipment to UHC
D Having a cousin who is a UHC employee in a different department
Correct Answer C
Rationale Serving on the board of a vendor that does business with UHC creates a
potential conflict requiring disclosure Ownership under 1 in a large public
company A is generally exempt B is not typically a conflict unless the spouse
influences contracting D is familial but not automatically a conflict unless
hierarchical or financial influence exists
5 Which law specifically prohibits offering any remuneration including kickbacks
or bribes to induce referrals of federal health care program business
A HIPAA Privacy Rule
B Stark Law
C Anti Kickback Statute
C False Claims Act
Correct Answer C Anti Kickback Statute
Rationale The federal Anti Kickback Statute 42 USC 1320a 7b makes it a felony to
knowingly offer pay solicit or receive remuneration to induce referrals for services
,paid by federal health care programs Stark Law B prohibits physician self referral
not kickbacks per se False Claims Act D addresses false billing HIPAA A addresses
privacy
6 A UHC claims processor accidentally deletes an appeal request from the
system and does not process it The member later discovers this and files a
complaint with CMS What is the best description of this conduct
A Fraud
B Waste
C Abuse
D Acceptable human error
Correct Answer C Abuse
Rationale Abuse involves actions that may be inconsistent with sound medical
business or fiscal practices but lack the intent to deceive or mislead needed for
fraud Fraud A requires knowing false representation Waste B is overutilization not
improper deletion of an appeal
7 Under UHC policy which of the following is considered protected activity under
the Code of Conduct
A Complaining to a coworker about a managers rudeness
B Refusing to commit an illegal act even if directed by a supervisor
C Posting negative comments about UHC on social media
D Quietly ignoring a violation to avoid conflict
Correct Answer B
Rationale Protected activity includes good faith reporting of misconduct or
refusing to follow illegal directives Social media posts C are generally not
protected unless whistleblowing rude comments A are not compliance related
ignoring D is the opposite of protected activity
8 A UHC sales agent tells a potential Medicare beneficiary You must buy this
plan today or you will lose your chance to enroll forever even though the
enrollment period is open for six more weeks This is an example of
A Permissible marketing
B Misleading or high pressure sales tactics
, C A correct statement of enrollment rules
D An acceptable way to close a sale
Correct Answer B
Rationale CMS marketing guidelines prohibit misleading statements creating false
urgency or pressuring beneficiaries Agents must provide accurate enrollment
period information
9 Which of the following is permitted under the UHC privacy policy regarding
protected health information PHI
A Sharing PHI with a spouse who calls to ask about a members diagnosis without
the members consent
B Leaving a detailed voicemail about a members lab results on an unsecured
answering machine
C Discussing a members PHI with another UHC employee who needs the
information to process an appeal
D Disposing of paper PHI in a regular trash bin
Correct Answer C
Rationale The minimum necessary standard and treatment payment operations
exceptions allow sharing PHI within UHC for legitimate business purposes without
patient authorization Spouse A requires authorization or the members presence
voicemail B requires reasonable safeguards trash D is impermissible proper
disposal requires shredding or locked bins
10 A manager asks an employee to backdate a prior authorization approval to
avoid an untimely determination penalty Which of the following is true
A The manager may be violating the False Claims Act if the backdated approval
leads to a false certification to CMS
B Backdating is acceptable if the original decision was clinically correct
C Only the manager faces liability the employee is protected
D This is a minor administrative error with no legal consequence
Correct Answer A
Rationale Backdating creates false records submitted to CMS potentially triggering
False Claims Act liability Both manager and employee B can face consequences no
C it is not minor D
