2025 AHIP General Compliance Updated Actual Questions and
Correct Answers (2026-2027)
Question 1.
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 Answer: Process the application properly (without the requested
revisions)—inform your supervisor and the compliance officer about the sales
agent's request
Question 2.
You are performing a regular inventory of the controlled substances in the pharmacy. You
discover a minor inventory discrepancy. What should you do?
Correct Answer: Follow your pharmacy's procedures
Question 3.
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 Answer: Although 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
Question 4.
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 Answer: Contact your compliance department (via compliance hotline or
other mechanism)
Question 5.
Ways to report a compliance issue include:
Correct Answer: All of the above
Correct Answers (2026-2027)
Question 1.
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 Answer: Process the application properly (without the requested
revisions)—inform your supervisor and the compliance officer about the sales
agent's request
Question 2.
You are performing a regular inventory of the controlled substances in the pharmacy. You
discover a minor inventory discrepancy. What should you do?
Correct Answer: Follow your pharmacy's procedures
Question 3.
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 Answer: Although 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
Question 4.
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 Answer: Contact your compliance department (via compliance hotline or
other mechanism)
Question 5.
Ways to report a compliance issue include:
Correct Answer: All of the above
