Medicare Parts C&D General Compliance Training

1.

What is noncompliance?
- A.
  
  Not agreeing to do something you are asked to do.
- B.
  
  Conduct that conforms to the law, but not Federal health care program requirements.
- C.
  
  Conduct that does not conform to the law, Federal health care program requirements, or to an organization's ethical and business policies.
- D.
  
  Violation of an organization's business policies but conduct that conforms to the law.
Correct Answer
C. Conduct that does not conform to the law, Federal health care program requirements, or to an organization's ethical and business policies.

Explanation
Noncompliance refers to conduct that does not adhere to the law, Federal health care program requirements, or an organization's ethical and business policies. It signifies actions or behavior that go against established rules and guidelines, potentially resulting in legal or ethical consequences.

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2.

A culture of compliance within an organization prevents, detects, and corrects noncompliance.
- A.
  
  True
- B.
  
  False
Correct Answer
A. True

Explanation
A culture of compliance within an organization is important because it ensures that all members of the organization are aware of and adhere to the rules, regulations, and ethical standards that govern their actions. This culture promotes a sense of responsibility and accountability, making it more likely that noncompliance will be prevented, detected, and corrected. By fostering a culture of compliance, organizations can minimize the risk of legal and ethical violations, maintain their reputation, and create a positive and ethical work environment.

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3.

What are the risks of noncompliance? (Select all that apply)
- A.
  
  Lower profits
- B.
  
  Higher Premiums
- C.
  
  Lower benefits for individuals and employers
- D.
  
  Computer malfunctions
Correct Answer(s)
A. Lower profits
B. Higher Premiums
C. Lower benefits for individuals and employers

Explanation
Noncompliance refers to the failure to comply with laws, regulations, or standards. The risks of noncompliance include lower profits because noncompliance can result in fines, penalties, or legal actions that can negatively impact a company's financial performance. Higher premiums are also a risk as insurance companies may increase premiums for noncompliant individuals or businesses. Additionally, noncompliance can lead to lower benefits for individuals and employers as they may not receive the full range of benefits or incentives available to compliant parties. Computer malfunctions, although a potential risk in general, are not directly related to noncompliance in this context.

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4.

What are the reporting methods that must be made available to you, if you are someone reporting noncompliance? (Select all that apply)
- A.
  
  Anonymous methods
- B.
  
  Confidential methods
- C.
  
  Non-retaliatory methods
- D.
  
  Customer support methods
Correct Answer(s)
A. Anonymous methods
B. Confidential methods
C. Non-retaliatory methods

Explanation
The reporting methods that must be made available to someone reporting noncompliance include anonymous methods, where the person can report without revealing their identity, confidential methods, where the person's identity is protected and kept confidential, and non-retaliatory methods, where the person reporting is protected from any form of retaliation. These methods ensure that individuals feel safe and secure when reporting noncompliance, encouraging them to come forward and disclose any wrongdoing without fear of negative consequences.

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5.

After noncompliance has been detected, 24 hours must go by before an investigation begins and correction can be implemented.
- A.
  
  True
- B.
  
  False
Correct Answer
B. False

Explanation
The statement is false because there is no specific time requirement mentioned for an investigation to begin and correction to be implemented after noncompliance is detected. The time frame can vary depending on the severity and urgency of the noncompliance. It is important to address noncompliance promptly to minimize potential risks and ensure compliance with regulations or standards.

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6.

Correcting noncompliance achieves the following: (Select all that apply)
- A.
  
  Avoids recurrence of the same noncompliance
- B.
  
  Promotes efficiency and effective internal controls
- C.
  
  Protects enrollees
- D.
  
  Creates unhappy employees
Correct Answer(s)
A. Avoids recurrence of the same noncompliance
B. Promotes efficiency and effective internal controls
C. Protects enrollees

Explanation
Correcting noncompliance achieves the following: avoiding recurrence of the same noncompliance, promoting efficiency and effective internal controls, and protecting enrollees. By addressing noncompliance, organizations can prevent similar issues from happening again in the future, ensuring that processes and procedures are followed correctly. This promotes efficiency and effective internal controls by establishing a culture of compliance and accountability. Additionally, correcting noncompliance protects enrollees by ensuring that they receive the appropriate and necessary services, and their rights and safety are upheld.

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7.

Those who engage in noncompliant behavior may be subject to any of the following EXCEPT:
- A.
  
  Mandatory training or retraining
- B.
  
  Disciplinary action
- C.
  
  Promotion
- D.
  
  Termination
Correct Answer
C. Promotion

Explanation
Engaging in noncompliant behavior can lead to various consequences such as mandatory training or retraining, disciplinary action, and termination. However, promotion is not typically a consequence for noncompliant behavior. In fact, individuals who engage in noncompliant behavior are less likely to be considered for promotions as it reflects negatively on their professionalism and adherence to rules and regulations. Therefore, the correct answer is promotion.

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8.

Which 2 activities help guarantee that noncompliance will not be repeated?
- A.
  
  Warning and termination
- B.
  
  Suspension and termination
- C.
  
  Monitoring and auditing
- D.
  
  Warning and salary adjustment
Correct Answer
C. Monitoring and auditing

Explanation
Monitoring and auditing are two activities that help guarantee that noncompliance will not be repeated. Monitoring involves continuously observing and assessing the compliance status to identify any deviations or violations. This helps in detecting noncompliance at an early stage and taking corrective actions promptly. Auditing, on the other hand, involves a systematic and independent examination of processes, procedures, and records to assess compliance with regulations and standards. It helps in evaluating the effectiveness of controls and identifying areas of improvement to prevent noncompliance in the future. By implementing monitoring and auditing activities, organizations can ensure that noncompliance is detected, addressed, and prevented in a proactive manner.

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9.

What are the 3 steps to making compliance a responsibility of yours when working for AX?
- A.
  
  Prevention
- B.
  
  Termination
- C.
  
  Detection & Reporting
- D.
  
  Correction
Correct Answer(s)
A. Prevention
C. Detection & Reporting
D. Correction

Explanation
The three steps to making compliance a responsibility when working for AX are prevention, detection & reporting, and correction. Prevention involves taking proactive measures to ensure compliance with laws, regulations, and company policies. Detection & reporting involves identifying any potential compliance issues and reporting them to the appropriate authorities. Correction involves taking necessary actions to rectify any non-compliance and prevent future occurrences. By following these steps, individuals can help maintain a culture of compliance within the organization.

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10.

What are methods of reporting noncompliance?
- A.
  
  Emailing a friend at work.
- B.
  
  G-chating (instant messaging) your manager.
- C.
  
  The method of reporting depends on what type of employee you are, but can include calling the medicare compliance officer, calling your ethics/compliance help line, or making a report through a sponsor's website
- D.
  
  Discussing it casually with the administrative assistant.
Correct Answer
C. The method of reporting depends on what type of employee you are, but can include calling the medicare compliance officer, calling your ethics/compliance help line, or making a report through a sponsor's website

Explanation
The correct answer explains that the method of reporting noncompliance depends on the type of employee. It suggests that options such as calling the medicare compliance officer, calling the ethics/compliance help line, or making a report through a sponsor's website are possible methods of reporting. This implies that there are specific channels and procedures in place for reporting noncompliance in different organizations or industries.

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Medicare Parts C&d General Compliance Training

What is noncompliance?

A culture of compliance within an organization prevents, detects, and corrects noncompliance.

What are the risks of noncompliance? (Select all that apply)

What are the reporting methods that must be made available to you, if you are someone reporting noncompliance? (Select all that apply)

After noncompliance has been detected, 24 hours must go by before an investigation begins and correction can be implemented.

Correcting noncompliance achieves the following: (Select all that apply)

Those who engage in noncompliant behavior may be subject to any of the following EXCEPT:

Which 2 activities help guarantee that noncompliance will not be repeated?

What are the 3 steps to making compliance a responsibility of yours when working for AX?

What are methods of reporting noncompliance?