2025 AHIP - GENERAL COMPLIANCE Q AND A

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2025 AHIP - GENERAL COMPLIANCE Q AND A

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2025/2026

Institution 2025 AHIP

Course 2025 AHIP

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2025 AHIP - GENERAL COMPLIANCE Q AND A

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2025 AHIP - GENERAL COMPLIANCE Q
AND A

Avbsalesvbagent,vbemployedvbbyvbthevbSponsor'svbfirst-
tier,vbdownstream,vborvbrelatedvbentityvb(FDR),vbsubmittedvbanvbapplicationvbforvbprocessi
ngvbandvbrequestedvbtwovbthings:vb1)vbtovbback-
datevbthevbenrollmentvbdatevbbyvbonevbmonth,vbandvb2)vbtovbwaivevballvbmonthlyvbpremiums
vbforvbthevbbeneficiary.vbWhatvbshouldvbyouvbdo?vb-vbanswer--

Processvbthevbapplicationvbproperlyvb(withoutvbthevbrequestedvbrevisions)—
informvbyourvbsupervisorvbandvbthevbcompliancevbofficervbaboutvbthevbsalesvbagent'svbrequ
est

Youvbarevbperformingvbavbregularvbinventoryvbofvbthevbcontrolledvbsubstancesvbinvbthevbpha
rmacy.vbYouvbdiscovervbavbminorvbinventoryvbdiscrepancy.vbWhatvbshouldvbyouvbdo?vb-
vbanswer--Followvbyourvbpharmacy'svbprocedures

YouvbworkvbforvbavbSponsor.vbLastvbmonth,vbwhilevbreviewingvbavbCentersvbforvbMedicarevb
&vbMedicaidvbServicesvb(CMS)vbmonthlyvbreport,vbyouvbidentifiedvbmultiplevbindividualsvbn
otvbenrolledvbinvbthevbplanvbbutvbforvbwhomvbthevbSponsorvbisvbpaid.vbYouvbspokevbtovbyourvb
supervisorvbwhovbsaidvbdon'tvbworryvbaboutvbit.vbThisvbmonth,vbyouvbidentifyvbthevbsamevbe
nrolleesvbonvbthevbreportvbagain.vbWhatvbshouldvbyouvbdo?vb-vbanswer--
AlthoughvbyouvbknowvbaboutvbthevbSponsor'svbnon-
retaliationvbpolicy,vbyouvbarevbstillvbnervousvbaboutvbreporting—
tovbbevbsafe,vbyouvbsubmitvbavbreportvbthroughvbyourvbcompliancevbdepartment'svbanonym
ousvbtipvblinevbtovbavoidvbidentification

Youvbdiscovervbanvbunattendedvbemailvbaddressvborvbfaxvbmachinevbinvbyourvbofficevbrecei
vingvbbeneficiaryvbappealsvbrequests.vbYouvbsuspectvbnovbonevbisvbprocessingvbthevbappe
als.vbWhatvbshouldvbyouvbdo?vb-vbanswer--
Contactvbyourvbcompliancevbdepartmentvb(viavbcompliancevbhotlinevborvbothervbmechanis
m)

Waysvbtovbreportvbavbcompliancevbissuevbinclude:vb-vbanswer--Allvbofvbthevbabove

Atvbavbminimum,vbanvbeffectivevbcompliancevbprogramvbincludesvbfourvbcorevbrequirement
s.vb-vbanswer--False

Whatvbarevbsomevbofvbthevbconsequencesvbforvbnon-
compliance,vbfraudulent,vborvbunethicalvbbehavior?vb-vbanswer--Allvbofvbthevbabove

Correctingvbnon-compliance________.vb-vbanswer--
Protectsvbenrollees,vbavoidsvbrecurrencevbofvbsamevbnon-
compliance,vbandvbpromotesvbefficiency

Whatvbisvbthevbpolicyvbofvbnon-retaliation?vb-vbanswer--
Protectsvbemployees,vbwhovbinvbgoodvbfaithvbreportvbsuspectedvbnon-compliance

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Uploaded on: August 26, 2025
Number of pages: 2
Written in: 2025/2026
Type: Exam (elaborations)
Contains: Questions & answers

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