You discover an unattended email address or fax machine in your office that receives beneficiary appeals requests. You suspect that no one is processing the appeals. What should you do?
A. Contact law enforcement
B. No
...
You discover an unattended email address or fax machine in your office that receives beneficiary appeals requests. You suspect that no one is processing the appeals. What should you do?
A. Contact law enforcement
B. Nothing
C. Contact your compliance department
D. Wait to confirm someone is processing the appeals before taking further action
E. Contact your supervisor - C. Contact your compliance department
At CVS health, you can use the Ethics Line
A sales agent employed by the Sponsor's First-Tier or Downstream entity, submitted an application for processing and requested to things. 1. to back-date enrollment date by one month, and 2. to waive all monthly premiums for the beneficiary. What should you do?
A. Refuse to change the date or waive the premiums, but decide not to mention the request to a supervisors or the compliance department
B. Make the requested changes because the sales agent determines the beneficiary's start date and monthly premiums
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. Process the application properly (without the requested revisions), inform your supervision and the compliance officer about the sales agent's request
E. Contact law enforcement and the Centers for Medicare & Medicaid Services (CMS) to report the sales agent's behaviro - D. Process the application properly (without the requested revisions), inform your supervision and the compliance officer about the sales agent's request
You work for a Sponsor. Last month, while reviewing a monthly report from the Centers for Medicare & Medicaid Services (CMS), you identified multiple enrollees for which the Sponsor is being paid, who are not enrolled in the plan. You spoke yo your supervisor who said not to worry about it. This month, you have identified the same enrollees on the report again. What should you do?
A. Decide not to worry about it as your supervisor instructed - you notified him last month and now its his responsibility
B. Although you have seen notices 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 so you cannot be identified
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