AHIP - Discrimination, Fraud, Waste, & Abuse – 2026
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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? - 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? -
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? - 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? - ANSWER-
Process the application properly (without the requested
revisions)—inform your supervisor and the compliance officer
about the sales agent's request
What is the policy of non-retaliation? - ANSWER-Protects
employees, who in
good faith report suspected non-
compliance
Standards of Conduct are the same for every Medicare Parts C
and D sponsor.
- ANSWER-
False
Medicare Parts C and D sponsors are not required to have
a compliance
program. - ANSWER-
False
|| Most Recent Exam 2026-2027 Actual Complete Real
Exam Questions And Correct Answers (Expertly
Verified Answers) Already Graded A+ | Guaranteed
Success!! Newest Exam | Just Released!!– Instant
Download
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? - 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? -
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? - 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? - ANSWER-
Process the application properly (without the requested
revisions)—inform your supervisor and the compliance officer
about the sales agent's request
What is the policy of non-retaliation? - ANSWER-Protects
employees, who in
good faith report suspected non-
compliance
Standards of Conduct are the same for every Medicare Parts C
and D sponsor.
- ANSWER-
False
Medicare Parts C and D sponsors are not required to have
a compliance
program. - ANSWER-
False
