Regulators
Compliance
Fraud, Waste & Abuse
Conflicts of Interest
Data Privacy & You
200
It is important you know how to address unscheduled audits, investigations, and/or subpoenas by a government entity. What Compliance policy addresses these items?
- CC.COMP.00
- CC.COMP.01
- CC.COMP.13
- CC.COMP.08
What is CC.COMP.08?
200
Why is it important to have written Compliance standards and policies?
- To guide employees and management in their roles and responsibilities.
- To document legal, regulatory and internal requirements.
- To assist in creating a Culture of Compliance.
- All of the above.
What is all of the above.
200
How does CMS define program integrity?
- Pay it forward
- Pay it right
- Do your best
- CMS does not define it
What is pay it right.
200
Which policy addresses Conflicts of Interest?
A. CC.COMP.23
B. CC.COMP.10
C. CC.COMP.13
D. CC.COMP.08
What is CC.COMP.13?
200
Protected Health Information (PHI) includes which of the following?
A. Claims History
B. Enrollment Activity
C. Notes from Doctor Visits
D. All of the above
What is D. All of the Above?
400
Which product would a Department of Insurance typically regulate?
- Medicaid
- D-SNP
- Marketplace
- LTSS
What is Marketplace?
400
Why are the Seven Elements critical for an effective Compliance Program?
- They provide standards for preventing fraud, waste, and abuse.
- They provide a framework to promote ethical conduct and reduce the risk of misconduct.
- The elements aren’t required, but are nice to have in case auditors ask.
- They help to increase office productivity.
What is they provide a framework to promote ethical conduct and reduce the risk of misconduct.
400
What is an example of a step you as an empkoyee might take to prevent fraud, waste and abuse?
- Carefully review information and documentation submitted with a prior authorization request to ensure alignment with policy.
- Only seek access to systems and data if you need it to complete your work.
- Assist in enforcing effective payment and clinical policies.
- All of the above.
What is all of the above?
400
When should you report a potential or actual Conflic of Interest?
A. Wait a week to see if it resolves itself
B. Within 5 business days
C. Never
D. As soon as you become aware of the situation.
What is D. As soon as you become aware of the situation?
400
Which department would you contact immediately if you become aware of a data privacy incident?
What is Enterprise Privacy Department?
600
The Center for Medicare & Medicaid Services (CMS) is a part of which broader government agency?
- SOL
- HHS
- CMS
- CNC
What is HHS?
600
Why are open lines of communication important for Centene's Compliance Program?
A. To encourage a culture of communication, transparency, and accountability.
B. To allow employees to express concerns without fear of retaliation.
C. To scare employees into doing what is right.
D. Both A and B
What is Both A and B?
600
True or False: Centene's FWA hotline allows for anonymous reporting.
What is True...
600
When are CenTeamers required to submit a COI questionnaire?
A. Upon hire
B. Annually
C. Ad Hoc, if a new situation arises.
D. All of the Above
What is D. All of the Above?
600
Centene collects confidential information from which of the following?
A. member and Providers only
B. Members, Employees, Providers, and Business Partners
C. Providers and Business Partners only
D. Members only
What is Members, Employees, Providers, and Business Partners?
800
Who should you reach out to if you are contacted unexpectedly by a regulator?
A. Product, Market or Business Unit Compliance Officer
B. Centene Data Privacy Department
C. Centene Ethics & Compliance Department
D. A or C
What is D. A or C?
800
Who can you report your concerns to?
- The Centene Compliance Hotline
- The Department of Motor Vehicles
- Your co-worker
- All of the above
What is The Centene Compliance Hotline?
800
Assisting in the implementation of corrective actions plans (or CAPs) is an example of which component of program integrity?
- Prevention
- Detection
- Correction
- None of the Above
What is correction?
800
True or False: An IT Director encourages Centene's IT Department to purchase software in which they have an ownership interest. This a Conflict of Interest.
A. True, it is a potential conflict of interest.
B. False, it is not a Conflict of Interest and no need to report.
What is A. True, it is a potential conflict of interest.
800
Confidental information such as a Social Security number and Drivers License number are considered:
A. PHI
B. COI
C. PII
D. All of the above
What is PII?
1000
Approximately how many members do we serve through our health plans, including Medicare, Medicaid, the Children’s Health Insurance Program, and Marketplace?
- 35.8 million
- 19.7 million
- 28.5 million
- 52.0 million
What is 28.5 million?
1000
True or False: As a government-sponsored healthcare plan, Centene is often asked by our regulators to provide evidence that its Compliance Program has incorporated the Seven Elements.
- True
- False
What is True?
1000
You can report suspected Fraud, Waste and Abuse to which of the following?
- Security: 1-800-CNC.SAFE
- Ask HR: 1-833-GoAskHR
- Centene's FWA: 1-866-685-8664
- Cyber Security: 1-833-34-CYBER
What is Centene's FWA: 1-866-685-8664?
1000
Where is the COI Dashboard found?
A. Workday
B. Centene University
C. Amisys
D. Archer
What is D. Archer?
1000
True or False: Privacy incidents can include email errors, unauthorized disclosures, mailing and shipping errors.
What is True?