2025 AHIP - GENERAL COMPLIANCE
EXAM QUESTIONS & DETAILED
CORRECT ANSWERS
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
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
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
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)
Ways to report a compliance issue include: - correct answer ✔✔All of the above
At a minimum, an effective compliance program includes four core requirements. - correct
answer ✔✔False
EXAM QUESTIONS & DETAILED
CORRECT ANSWERS
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
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
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
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)
Ways to report a compliance issue include: - correct answer ✔✔All of the above
At a minimum, an effective compliance program includes four core requirements. - correct
answer ✔✔False
