CMS Professional Ethics & Communication 2

Question 1

A CMS specialist discovers that a colleague has been submitting claims with inflated service units. What is the MOST appropriate immediate action?

Accepted Answer

Report the concern through the organization's compliance hotline

Answer

Compliance hotlines provide a confidential, appropriate channel for reporting suspected fraud without retaliation risk.

Question 2

Under the Medicare marketing guidelines, which communication method is PROHIBITED when contacting a Medicare beneficiary for the first time?

Accepted Answer

Making an unsolicited door-to-door visit

Answer

CMS prohibits agents from making unsolicited door-to-door contacts with Medicare beneficiaries as a marketing tactic.

Question 3

A Medicare Advantage plan enrollee asks a specialist to explain their out-of-pocket maximum. What ethical obligation does this create?

Accepted Answer

The specialist must provide a clear, accurate explanation in plain language

Answer

Ethical and regulatory standards require specialists to communicate benefit information clearly and accurately to beneficiaries.

Question 4

Which of the following BEST describes a conflict of interest for a CMS specialist?

Accepted Answer

Recommending a plan because it pays the highest commission

Answer

Recommending a plan based on commission rather than beneficiary need is a classic conflict of interest that violates ethical standards.

Question 5

A specialist receives a gift card from a Medicare plan vendor after enrolling a large number of members. How should the specialist handle this?

Accepted Answer

Decline it as it may constitute an improper inducement

Answer

Accepting gifts from plan vendors can violate anti-kickback statutes and CMS marketing guidelines prohibiting improper inducements.

(CMS) Certified Medicare Specialist Practice Test