800662 Medicare Part C&D with complete solutions

You discover an unattended email address or fax machine in your office that recieves benwficiary appeals requests. You suspect that no one is processing the appeals. What should you do? C. Contact your compliance department (via compliance hotline or other mechanism) A sales agent employed by the sponsors first tier or downstream entity, submitted an application for processing and requested two things. 1. To back date the enrollment date by one month. 2. To waive all monthly premiums for the beneficiary. What should you do? Process the application properly (without the requested revisions)- inform your supervisor and the compliance officer about the sale agents request You work for a sponsor. Last month, while reviewing a monthly report from the centers for Medicare and Medicaid services, you identified multiple enrollees for which the sponsor is being paid, who are not enrolled in the plan. You spoke to your supervisor and who said not to worry about it. This month, you have identified the same enrollees on the report again. What should you do? Although you have seen notices about the sponsors non-retaliation policy, you are still nervous about reporting - to be safe, you submit a report through your compliance departments anonymous tip line so you cannot be identified You are performing a regular inventory of the controlled substance in the pharmacy. You discover a minor inventory discrepancy. What should you do? Follow your Pharmacy's procedure Standards of conduct are the same for every Medicare parts c and d sponsor False Ways to report a compliance issue include A telephone B report to sponsors website C in person reporting to the compliance department / supervisor D. All the above All the above Once a corrective action plans begins addressing non compliance or fraud, waste, and abuse committed by a sponsors employee or first tier, downtown or related entity's employee ongoing monitoring of the corrective actions is not necessary False At a minimum an effective compliance program includes all four core requirements False Compliance is the responsibility of the compliance officer, compliance committee and upper management only False Medicare parts C & D plan sponsors are not required to have a compliance program False What's the policy of non retaliation C. Protects employees who, in good faith, report suspected non-compliance Correcting non compliance A. Protects enrollees, avoids recurrence of the same non-compliance and promotes efficiency These are examples of issues that can be reported to a compliance director - suspected fraud waste and abuse - potential healthy privacy violation - unethical behavior/ employee misconduct True What are some of the consequences for non-compliance fraudulent or unethical behavior D. All the above