AHIP - Discrimination, Fraud, Waste, &
Abuse (Latest Updates)
Questions & Answers 100% Correct
{Grade A}
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? - correct answer 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? - correct answer Contact your compliance department (via compliance
hotline or other mechanism)
, You are performing a regular inventory of the controlled substances in the pharmacy.
You discover a minor inventory discrepancy. What should you do? - correct answer
Follow your pharmacy's procedures
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? - correct answer Process the application properly
(without the requested revisions)—inform your supervisor and the compliance officer
about the sales agent's request
Standards of Conduct are the same for every Medicare Parts C and D sponsor. -
correct answer False
Medicare Parts C and D sponsors are not required to have a compliance program. -
correct answer False
Ways to report a compliance issue include: - correct answer A: all of the above
Abuse (Latest Updates)
Questions & Answers 100% Correct
{Grade A}
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? - correct answer 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? - correct answer Contact your compliance department (via compliance
hotline or other mechanism)
, You are performing a regular inventory of the controlled substances in the pharmacy.
You discover a minor inventory discrepancy. What should you do? - correct answer
Follow your pharmacy's procedures
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? - correct answer Process the application properly
(without the requested revisions)—inform your supervisor and the compliance officer
about the sales agent's request
Standards of Conduct are the same for every Medicare Parts C and D sponsor. -
correct answer False
Medicare Parts C and D sponsors are not required to have a compliance program. -
correct answer False
Ways to report a compliance issue include: - correct answer A: all of the above
