AHIP - General Compliance
questions and answers 2024\2025
A+ Grade
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
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
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)
Ways to report a compliance issue include:
- correct answer All of the above
questions and answers 2024\2025
A+ Grade
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
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
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)
Ways to report a compliance issue include:
- correct answer All of the above
