UHC Ethic and Compliance 2022 Study Guide, Q&A COMPLETE SOLUTION GUIDE

What is the definition of Abuse? - Abuse includes any practice that results in the provision of services that are not medically necesary An agent should only enroll a consumer in a product: - That is suitable for the consumer's needs, goals and financial resources. When marketing UnitedHealthcare Medicare Advantage plans to consumers, which of the following must an agent do? - Provide current marketing materials that have been approved by CMS and UnitedHealthcare. Agent Jacob learns that Emily, the consumer with whom he is meeting, is the authorized legal representative for her father. What must Jacob explain to Emily when completing an Enrollment Application for her father? - Jacob must explain that Emily will sign the Enrollment Application and must be able to provide documentation upon request by the Plan that indicates her legal authority to enroll her father. When can telephonic contact with a Medicare eligible consumer be made? - When the consumer consented to be contacted for sales activities, subsequent telephonic contact has not yet occurred, and the permission has not yet expired. An individual with Power of Attorney is an example of what authority? - Legal authority under state law to act on behalf of another individual. Janine, currently enrolled in a 3-star plan, discovers there is 5-star plan available where she lives. She asks her agent, Josh, to enroll her in the 5-star plan. Josh can advise Janine of each of the following except: - Josh should tell Janine that she can only change her current plan to a 5-star plan during the Annual Election Period. Educational events allow for which of the following to occur? - Provide objective information about the Medicare program and/or health improvement and wellness.Dino, an agent, received a phone call on September 29 from a consumer interested in Medicare Advantage plans for the new plan year. Dino proceeded to verify the consumer's Medicare eligibility, describe the costs and benefit coverage of the plan, and explained that he could not accept an enrollment application until October 15. What did Dino do that was NOT compliant? - Dino presented a plan prior to October 1. Annual Election Period (AEP) is a time when: - Consumers can elect to join a Medicare Advantage Plan or switch to a different plan. What type of events must an agent report to UnitedHealthcare? - Formal and informal marketing/sales events Which of the following are the ways to report potential FWA? - Producer Help Desk (DHP) Fraud, Waste and/or Abuse hotline