Question

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
C. 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 records _ if they are, then you will say something to your supervisor again
D. Contact law enforcement and the CMS to report the discrepancy
E. Ask your supervisor about the discrepancy again

Answer 1

If you have identified enrollees not enrolled in the plan, report the discrepancy through the compliance department's anonymous tip line.

Step-by-step explanation:

If you have identified multiple enrollees for which the Sponsor is being paid, who are not enrolled in the plan, it is important to take appropriate action. Given that you have already spoken to your supervisor and they dismissed your concerns, it may be best to escalate the issue to the compliance department. This can be done by submitting a report through the compliance department's anonymous tip line to ensure your anonymity.

Waiting for a few more months to see if the same enrollees appear on the report again is not advisable, as it could be a recurring issue that needs immediate attention. Similarly, taking matters into your own hands by contacting law enforcement and CMS may not be necessary at this point. By reporting the discrepancy through the compliance department, you are following the appropriate channels and ensuring that the issue is addressed by the relevant team.

Answer 2

B.

Step-by-step explanation:

Based on the scenario being described and the different options listed, it seems that the best option is that 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. This will make sure that the various enrollees that are getting paid but are not enrolled get looked into by the proper authorities while at the same time staying completely anonymous and making sure that your job is safe.