Medicare Parts C & D General Compliance
You work for a Sponsor. Last month, while reviewing a 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.
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.
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.
