2025 AHIP - General
Compliance Study
Assessment Questions With
Correct Answers 2025-2026
GRADED A +
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? - ANS-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? -
ANS-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? - ANS-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? - ANS-Contact your compliance department (via
compliance hotline or other mechanism)
Ways to report a compliance issue include: - ANS-All of the above
Compliance Study
Assessment Questions With
Correct Answers 2025-2026
GRADED A +
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? - ANS-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? -
ANS-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? - ANS-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? - ANS-Contact your compliance department (via
compliance hotline or other mechanism)
Ways to report a compliance issue include: - ANS-All of the above
