2024 General Compliance Module
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? 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? 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? 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?
Contact your compliance department (via compliance hotline or other mechanism)
Compliance is the responsibility of the Compliance Officer, Compliance Committee, and Upper
Management only. False
What are some of the consequences for non-compliance, fraudulent, or unethical behavior?
a.Disciplinary action
b.Termination of employment
c.Exclusion from participating kin all Federal health care programs
d.All of the above*****
Medicare Parts C and D sponsors are not required to have a compliance program. False
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? 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? 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? 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?
Contact your compliance department (via compliance hotline or other mechanism)
Compliance is the responsibility of the Compliance Officer, Compliance Committee, and Upper
Management only. False
What are some of the consequences for non-compliance, fraudulent, or unethical behavior?
a.Disciplinary action
b.Termination of employment
c.Exclusion from participating kin all Federal health care programs
d.All of the above*****
Medicare Parts C and D sponsors are not required to have a compliance program. False
