AHIP - GENERAL COMPLIANCE LATEST ACTUAL EXAM
WITH VERIFIED QUESTIONS & CORRECT ANSWERS
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?
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?
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?
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?
ANSWER
Contact your compliance department (via compliance hotline or other mechanism)
Question 5.
Ways to report a compliance issue include:
ANSWER
All of the above
1
WITH VERIFIED QUESTIONS & CORRECT ANSWERS
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?
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?
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?
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?
ANSWER
Contact your compliance department (via compliance hotline or other mechanism)
Question 5.
Ways to report a compliance issue include:
ANSWER
All of the above
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