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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
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? Question 1Answer a. Refuse to change the date or waive the premiums but decide not to mention the request to a supervisor or the compliance department b. Process the application properly (without the requested revisions)inform your supervisor and the compliance officer about the sales agent's request c. Tell the sales agent you will take care of it but then process the application properly (without the requested revisions)you will not file a report because you don't want the sales agent to retaliate against you d. Contact law enforcement and the Centers for Medicare & Medicaid Services (CMS) to report the sales agent's behavior e. Make the requested changes because the sales agent determines the beneficiary's start date and monthly premiums Question 2 Not yet answered 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? Question 2Answer a. Decide not to worry about it as your supervisor instructedyou notified your supervisor last month and now it's his responsibility b. Wait until the next month to see if the same enrollees appear on the report again, figuring it may take a few months for CMS to reconcile its recordsif they are, then you will say something to your supervisor again c. Ask your supervisor about the discrepancy again d. Although you know about the Sponsor's non-retaliation policy, you are still nervous about reportingto be safe, you submit a report through your compliance department's anonymous tip line to avoid identification e. Contact law enforcement and CMS to report the discrepancy Question 3 Not yet answered 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? Question 3Answer a. Contact your supervisor b. Wait to confirm someone is processing the appeals before taking further action c. Contact law enforcement d. Contact your compliance department (via compliance hotline or other mechanism) e. Nothing Question 4 Not yet answered You are performing a regular inventory of the controlled substances in the pharmacy. You discover a minor inventory discrepancy. What should you do? Question 4Answer a. Discuss your concerns with your supervisor b. Call local law enforcement c. Perform another review d. Follow your pharmacy's procedures e. Contact your compliance department (via compliance hotline or other mechanism)
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