UHC Ethics & Compliance | 2026/2027 UnitedHealthcare
UHC Ethics & Compliance Certification Exam
(Solved) Latest 2026/2027 Complete Solutions
UnitedHealthcare · Verified Answers · Distinction-Level Study Guide
Instructions: This comprehensive examination contains 60 multiple-choice questions across 6 content domains aligned with
the 2026/2027 UnitedHealthcare Ethics & Compliance certification blueprint. Each question has one best answer. Cognitive
distribution: 35% recall, 45% application, 20% analysis. Rationales include federal regulatory citations (FCA, AKS, Stark,
HIPAA, FCPA, OIG), UHC policy alignment, and distinction-level study notes. Estimated time: 90 minutes.
Section 1: Ethics Foundations and Code of Conduct (Core Values, Ethical Principles, &
Professional Standards)
Q1. Which set of values represents the core ethical principles guiding UnitedHealthcare's Code of Conduct?
A. Speed, Efficiency, Profitability, and Market Share.
B. Integrity, Compassion, Relationships, Innovation, and Performance. [CORRECT]
C. Confidentiality, Hierarchy, Tradition, and Loyalty.
D. Competition, Discretion, Authority, and Growth.
Correct Answer: B
Rationale: UnitedHealthcare's Code of Conduct is built on the core values of Integrity, Compassion, Relationships,
Innovation, and Performance. These values guide ethical decision-making and are the foundation for all compliance-related
conduct. The other options represent business priorities that are not aligned with UHC's published values. Success strategy:
When asked for UHC core values, select the answer containing 'Integrity, Compassion, Relationships, Innovation, and
Performance.'
Q2. A UnitedHealthcare employee observes a colleague making a decision that, while not explicitly illegal,
appears to conflict with the company's stated values. Which action should the employee take FIRST?
A. Wait to see if the behavior continues before reporting.
B. Discuss the concern with the colleague and, if unresolved, report through the Ethics & Compliance hotline or
management chain. [CORRECT]
C. Post the concern on social media to raise awareness.
D. Confront the colleague publicly to stop the behavior immediately.
Correct Answer: B
Rationale: UHC's Code of Conduct encourages employees to first raise concerns directly with the involved party when
appropriate, but if unresolved or if the issue is serious, escalate through the Ethics & Compliance hotline, supervisor, or HR.
Waiting allows harm to continue, public posting violates confidentiality, and public confrontation is unprofessional. Success
strategy: When asked 'FIRST,' look for the option that seeks to address the concern through appropriate internal channels.
Q3. Which of the following BEST describes the distinction between ethics and compliance?
A. Ethics refers to mandatory legal requirements; compliance refers to voluntary standards.
B. Ethics refers to voluntary standards of conduct based on values; compliance refers to mandatory adherence to
laws, regulations, and organizational policies. [CORRECT]
C. Ethics and compliance are interchangeable terms.
D. Compliance is optional; ethics is mandatory.
Correct Answer: B
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Rationale: Ethics encompasses voluntary standards of conduct grounded in values (what is right), while compliance refers to
mandatory adherence to laws, regulations, and organizational policies (what is required). They overlap but are not identical.
Success strategy: Ethics = voluntary/values; Compliance = mandatory/laws and policies.
Q4. An employee receives a call from someone claiming to be a member's family member requesting details
about the member's recent claim. The caller is emotional and insists the information is urgently needed. What
is the appropriate response?
A. Provide the claim information because the caller is a family member and the situation is urgent.
B. Decline to disclose PHI without the member's authorization or verification of a permitted disclosure basis;
verify identity and document the request. [CORRECT]
C. Transfer the call to a supervisor who can decide whether to disclose.
D. Provide the information and document that the caller seemed legitimate.
Correct Answer: B
Rationale: PHI cannot be disclosed to family members without the member's authorization or a permitted HIPAA exception
(e.g., emergency circumstances with professional judgment). Emotional urgency does not override HIPAA requirements. The
employee must verify identity and document the request, declining if no permitted basis exists. Success strategy: When asked
about disclosures to family, look for the option requiring authorization or a specific HIPAA-permitted basis.
Q5. Which of the following scenarios represents a potential conflict between UHC's core value of Integrity
and a business decision?
A. A team accurately reports quality metrics even when results are below target.
B. A leader pressures staff to round down error rates in a quality report to meet performance goals. [CORRECT]
C. An employee reports a concern about a colleague's behavior through the hotline.
D. A manager documents a corrective action plan for an identified compliance gap.
Correct Answer: B
Rationale: Integrity requires honesty and accuracy in all communications and reporting. Pressuring staff to round down error
rates to meet performance goals directly violates integrity and constitutes a compliance violation. The other options reflect
integrity in action. Success strategy: Look for the option involving deliberate misrepresentation or pressure to manipulate data
when integrity is being tested.
Q6. UnitedHealthcare's Code of Conduct applies to which of the following groups?
A. Only full-time employees of UnitedHealthcare.
B. Only senior leadership and board members.
C. All employees, contractors, vendors, and representatives acting on behalf of UnitedHealthcare. [CORRECT]
D. Only employees who handle PHI.
Correct Answer: C
Rationale: UHC's Code of Conduct applies to all employees, contractors, temporary workers, vendors, and any representatives
acting on behalf of the organization. The Code is not limited to specific roles or employment types. Success strategy: When
asked who the Code applies to, choose the broadest group that includes anyone acting on UHC's behalf.
Q7. A UHC employee is offered a job by a current vendor while still employed at UHC and is involved in
decisions affecting that vendor. What is the appropriate action under UHC's Code of Conduct?
A. Accept the offer quietly and continue making decisions about the vendor.
B. Disclose the job offer and relationship to the supervisor and Ethics & Compliance, and recuse from decisions
involving the vendor. [CORRECT]
C. Decline the offer without disclosure because it is a personal matter.
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D. Accept the offer and disclose only if the vendor relationship changes.
Correct Answer: B
Rationale: A pending job offer with a vendor creates a conflict of interest. UHC's Code requires disclosure and recusal from
decisions involving the vendor to maintain objectivity. Quietly continuing to make decisions is a conflict of interest violation.
Success strategy: When a potential COI arises (job offer, financial interest, family relationship), the correct action is disclose +
recuse.
Q8. Which statement BEST reflects UHC's standards of professional behavior?
A. Professional behavior is required only when interacting with external clients.
B. Employees must treat colleagues, members, providers, and partners with respect, dignity, and professionalism
in all interactions. [CORRECT]
C. Professional behavior is optional and depends on the work environment.
D. Professional behavior is enforced only when documented in performance reviews.
Correct Answer: B
Rationale: UHC's Code requires respectful, dignified, and professional conduct toward all colleagues, members, providers,
and partners in all interactions, not just external ones. Professionalism is a continuous standard, not optional or contingent on
documentation. Success strategy: When asked about professional behavior, choose the option emphasizing respect across all
stakeholders and all settings.
Q9. Accountability under UHC's Code of Conduct means that employees:
A. Are responsible only for their own direct actions and not for reporting others.
B. Are responsible for their own conduct AND for raising concerns about potential violations they observe.
[CORRECT]
C. Are accountable only to their direct supervisor.
D. Cannot be held accountable for actions directed by management.
Correct Answer: B
Rationale: Accountability means employees are responsible for their own conduct and for raising concerns about observed
violations. Following an unlawful directive does not absolve responsibility. Success strategy: Accountability = personal conduct
+ duty to report; management direction does not excuse violations.
Q10. An employee is unsure whether a particular action complies with UHC's Code of Conduct. What should
they do FIRST?
A. Proceed with the action and ask for forgiveness if it is wrong.
B. Seek guidance from their supervisor, the Ethics & Compliance team, or the hotline before taking the action.
[CORRECT]
C. Ask a colleague informally and follow their advice.
D. Wait until a policy is updated to clarify the situation.
Correct Answer: B
Rationale: When unsure about compliance, employees should seek guidance before acting. UHC provides multiple resources
including supervisors, the Ethics & Compliance team, and the hotline. Proceeding without clarification risks violation;
informal advice or waiting is not appropriate. Success strategy: When asked what to do when unsure, choose 'seek guidance
first.'
Q11. Which of the following BEST describes UHC's commitment to its members under the Code of Conduct?
A. Maximize shareholder returns above all other considerations.
Page 3
UHC Ethics & Compliance Certification Exam
(Solved) Latest 2026/2027 Complete Solutions
UnitedHealthcare · Verified Answers · Distinction-Level Study Guide
Instructions: This comprehensive examination contains 60 multiple-choice questions across 6 content domains aligned with
the 2026/2027 UnitedHealthcare Ethics & Compliance certification blueprint. Each question has one best answer. Cognitive
distribution: 35% recall, 45% application, 20% analysis. Rationales include federal regulatory citations (FCA, AKS, Stark,
HIPAA, FCPA, OIG), UHC policy alignment, and distinction-level study notes. Estimated time: 90 minutes.
Section 1: Ethics Foundations and Code of Conduct (Core Values, Ethical Principles, &
Professional Standards)
Q1. Which set of values represents the core ethical principles guiding UnitedHealthcare's Code of Conduct?
A. Speed, Efficiency, Profitability, and Market Share.
B. Integrity, Compassion, Relationships, Innovation, and Performance. [CORRECT]
C. Confidentiality, Hierarchy, Tradition, and Loyalty.
D. Competition, Discretion, Authority, and Growth.
Correct Answer: B
Rationale: UnitedHealthcare's Code of Conduct is built on the core values of Integrity, Compassion, Relationships,
Innovation, and Performance. These values guide ethical decision-making and are the foundation for all compliance-related
conduct. The other options represent business priorities that are not aligned with UHC's published values. Success strategy:
When asked for UHC core values, select the answer containing 'Integrity, Compassion, Relationships, Innovation, and
Performance.'
Q2. A UnitedHealthcare employee observes a colleague making a decision that, while not explicitly illegal,
appears to conflict with the company's stated values. Which action should the employee take FIRST?
A. Wait to see if the behavior continues before reporting.
B. Discuss the concern with the colleague and, if unresolved, report through the Ethics & Compliance hotline or
management chain. [CORRECT]
C. Post the concern on social media to raise awareness.
D. Confront the colleague publicly to stop the behavior immediately.
Correct Answer: B
Rationale: UHC's Code of Conduct encourages employees to first raise concerns directly with the involved party when
appropriate, but if unresolved or if the issue is serious, escalate through the Ethics & Compliance hotline, supervisor, or HR.
Waiting allows harm to continue, public posting violates confidentiality, and public confrontation is unprofessional. Success
strategy: When asked 'FIRST,' look for the option that seeks to address the concern through appropriate internal channels.
Q3. Which of the following BEST describes the distinction between ethics and compliance?
A. Ethics refers to mandatory legal requirements; compliance refers to voluntary standards.
B. Ethics refers to voluntary standards of conduct based on values; compliance refers to mandatory adherence to
laws, regulations, and organizational policies. [CORRECT]
C. Ethics and compliance are interchangeable terms.
D. Compliance is optional; ethics is mandatory.
Correct Answer: B
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,UHC Ethics & Compliance | 2026/2027 UnitedHealthcare
Rationale: Ethics encompasses voluntary standards of conduct grounded in values (what is right), while compliance refers to
mandatory adherence to laws, regulations, and organizational policies (what is required). They overlap but are not identical.
Success strategy: Ethics = voluntary/values; Compliance = mandatory/laws and policies.
Q4. An employee receives a call from someone claiming to be a member's family member requesting details
about the member's recent claim. The caller is emotional and insists the information is urgently needed. What
is the appropriate response?
A. Provide the claim information because the caller is a family member and the situation is urgent.
B. Decline to disclose PHI without the member's authorization or verification of a permitted disclosure basis;
verify identity and document the request. [CORRECT]
C. Transfer the call to a supervisor who can decide whether to disclose.
D. Provide the information and document that the caller seemed legitimate.
Correct Answer: B
Rationale: PHI cannot be disclosed to family members without the member's authorization or a permitted HIPAA exception
(e.g., emergency circumstances with professional judgment). Emotional urgency does not override HIPAA requirements. The
employee must verify identity and document the request, declining if no permitted basis exists. Success strategy: When asked
about disclosures to family, look for the option requiring authorization or a specific HIPAA-permitted basis.
Q5. Which of the following scenarios represents a potential conflict between UHC's core value of Integrity
and a business decision?
A. A team accurately reports quality metrics even when results are below target.
B. A leader pressures staff to round down error rates in a quality report to meet performance goals. [CORRECT]
C. An employee reports a concern about a colleague's behavior through the hotline.
D. A manager documents a corrective action plan for an identified compliance gap.
Correct Answer: B
Rationale: Integrity requires honesty and accuracy in all communications and reporting. Pressuring staff to round down error
rates to meet performance goals directly violates integrity and constitutes a compliance violation. The other options reflect
integrity in action. Success strategy: Look for the option involving deliberate misrepresentation or pressure to manipulate data
when integrity is being tested.
Q6. UnitedHealthcare's Code of Conduct applies to which of the following groups?
A. Only full-time employees of UnitedHealthcare.
B. Only senior leadership and board members.
C. All employees, contractors, vendors, and representatives acting on behalf of UnitedHealthcare. [CORRECT]
D. Only employees who handle PHI.
Correct Answer: C
Rationale: UHC's Code of Conduct applies to all employees, contractors, temporary workers, vendors, and any representatives
acting on behalf of the organization. The Code is not limited to specific roles or employment types. Success strategy: When
asked who the Code applies to, choose the broadest group that includes anyone acting on UHC's behalf.
Q7. A UHC employee is offered a job by a current vendor while still employed at UHC and is involved in
decisions affecting that vendor. What is the appropriate action under UHC's Code of Conduct?
A. Accept the offer quietly and continue making decisions about the vendor.
B. Disclose the job offer and relationship to the supervisor and Ethics & Compliance, and recuse from decisions
involving the vendor. [CORRECT]
C. Decline the offer without disclosure because it is a personal matter.
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, UHC Ethics & Compliance | 2026/2027 UnitedHealthcare
D. Accept the offer and disclose only if the vendor relationship changes.
Correct Answer: B
Rationale: A pending job offer with a vendor creates a conflict of interest. UHC's Code requires disclosure and recusal from
decisions involving the vendor to maintain objectivity. Quietly continuing to make decisions is a conflict of interest violation.
Success strategy: When a potential COI arises (job offer, financial interest, family relationship), the correct action is disclose +
recuse.
Q8. Which statement BEST reflects UHC's standards of professional behavior?
A. Professional behavior is required only when interacting with external clients.
B. Employees must treat colleagues, members, providers, and partners with respect, dignity, and professionalism
in all interactions. [CORRECT]
C. Professional behavior is optional and depends on the work environment.
D. Professional behavior is enforced only when documented in performance reviews.
Correct Answer: B
Rationale: UHC's Code requires respectful, dignified, and professional conduct toward all colleagues, members, providers,
and partners in all interactions, not just external ones. Professionalism is a continuous standard, not optional or contingent on
documentation. Success strategy: When asked about professional behavior, choose the option emphasizing respect across all
stakeholders and all settings.
Q9. Accountability under UHC's Code of Conduct means that employees:
A. Are responsible only for their own direct actions and not for reporting others.
B. Are responsible for their own conduct AND for raising concerns about potential violations they observe.
[CORRECT]
C. Are accountable only to their direct supervisor.
D. Cannot be held accountable for actions directed by management.
Correct Answer: B
Rationale: Accountability means employees are responsible for their own conduct and for raising concerns about observed
violations. Following an unlawful directive does not absolve responsibility. Success strategy: Accountability = personal conduct
+ duty to report; management direction does not excuse violations.
Q10. An employee is unsure whether a particular action complies with UHC's Code of Conduct. What should
they do FIRST?
A. Proceed with the action and ask for forgiveness if it is wrong.
B. Seek guidance from their supervisor, the Ethics & Compliance team, or the hotline before taking the action.
[CORRECT]
C. Ask a colleague informally and follow their advice.
D. Wait until a policy is updated to clarify the situation.
Correct Answer: B
Rationale: When unsure about compliance, employees should seek guidance before acting. UHC provides multiple resources
including supervisors, the Ethics & Compliance team, and the hotline. Proceeding without clarification risks violation;
informal advice or waiting is not appropriate. Success strategy: When asked what to do when unsure, choose 'seek guidance
first.'
Q11. Which of the following BEST describes UHC's commitment to its members under the Code of Conduct?
A. Maximize shareholder returns above all other considerations.
Page 3
