HCCA CHC/CHPC Compliance Exam 2026 –
Questions & Verified Answers | Latest Just
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HCCA CHC/CHPC COMPLIANCE EXAM 2026
Questions — Complete Study Bank with Verified Answers
Question 1 What are the Seven Elements of an Effective Compliance Program as
outlined by the OIG?
A. Policies, Auditing, Training, Reporting, Investigations, Discipline, Response
B. Leadership, Policies, Training, Monitoring, Reporting, Enforcement, Response
C. Written standards, Compliance leadership, Training, Communication,
Monitoring/auditing, Enforcement/discipline, Response/prevention
D. Governance, Policies, Education, Hotlines, Auditing, Sanctions, Corrective Action
E. Oversight, Documentation, Communication, Risk Management, Audits, Ethics,
Feedback
CORRECT ANSWER: C — Written standards, Compliance leadership, Training,
Communication, Monitoring/auditing, Enforcement/discipline,
Response/prevention
RATIONALE: The OIG's Compliance Program Guidance identifies seven core elements
every effective healthcare compliance program must include. These are: (1) Written
Policies and Procedures, (2) Compliance Officer and Compliance Committee, (3)
Education and Training, (4) Effective Lines of Communication, (5) Monitoring and
Auditing, (6) Enforcement/Discipline, and (7) Response/Correction. These elements
form the backbone of any OIG-recognized compliance framework and are tested heavily
on the CHC exam.
Question 2 Which federal agency issues Compliance Program Guidance documents
for healthcare organizations?
A. Centers for Medicare and Medicaid Services (CMS)
B. Department of Justice (DOJ)
C. Office of Inspector General (OIG)
, D. Office for Civil Rights (OCR)
E. Federal Bureau of Investigation (FBI)
CORRECT ANSWER: C — Office of Inspector General (OIG)
RATIONALE: The OIG, under the U.S. Department of Health and Human Services
(HHS), is the primary agency that issues Compliance Program Guidance (CPG)
documents tailored to specific segments of the healthcare industry, including hospitals,
nursing facilities, third-party billers, and others. The OIG's mission includes detecting
and preventing fraud, waste, and abuse in federal healthcare programs, and its CPGs
serve as voluntary roadmaps for building effective compliance programs.
Question 3 The False Claims Act (FCA) imposes civil penalties for each false claim
submitted to the federal government. What is the approximate per-claim penalty range
as of recent updates?
A. $1,000 – $5,000
B. $5,000 – $10,000
C. $13,000 – $27,000
D. $50,000 – $100,000
E. $100,000 – $250,000
CORRECT ANSWER: C — $13,000 – $27,000
RATIONALE: The False Claims Act (31 U.S.C. § 3729) is the primary tool the
government uses to combat fraud in federal healthcare programs. Civil penalties are
adjusted annually for inflation. As of recent updates, penalties range from approximately
$13,946 to $27,894 per false claim, plus treble (triple) damages. This makes FCA
liability potentially enormous for providers who submit large volumes of fraudulent
claims. CHC candidates must know both the penalty structure and the key provisions of
the FCA.
Question 4 Under the False Claims Act, what is the term for a private individual who
files a lawsuit on behalf of the government?
A. Complainant
B. Whistleblower
, C. Qui Tam Relator
D. Informant
E. Respondent
CORRECT ANSWER: C — Qui Tam Relator
RATIONALE: The False Claims Act contains a "qui tam" provision (Latin: "who as well")
that allows private individuals, known as "relators," to file lawsuits on behalf of the
government against those who have defrauded federal programs. Relators are entitled
to receive between 15–30% of any recovered funds, depending on whether the
government intervenes. This provision has been responsible for recovering billions of
dollars in healthcare fraud. Compliance officers must understand this mechanism as it
directly affects organizational risk.
Question 5 Which of the following best defines "fraud" in the context of healthcare
compliance?
A. An unintentional billing error resulting in overpayment
B. A negligent mistake in clinical documentation
C. An intentional deception or misrepresentation to obtain unauthorized benefit
D. A systemic pattern of minor coding errors
E. Failure to update compliance policies annually
CORRECT ANSWER: C — An intentional deception or misrepresentation to
obtain unauthorized benefit
RATIONALE: Healthcare fraud is defined as an intentional act of deception,
misrepresentation, or concealment of material facts to obtain money or benefits to which
one is not entitled. This distinguishes fraud from "abuse," which refers to practices that
are inconsistent with sound medical or business practices but may not involve
intentional deception. Understanding the distinction between fraud, waste, and abuse
(FWA) is fundamental to compliance work and is heavily tested on the CHC exam.
Question 6 What is the primary purpose of a Corporate Integrity Agreement (CIA)?
A. To fine healthcare organizations for billing errors
B. To permanently exclude providers from Medicare and Medicaid
, C. To allow providers to continue participating in federal programs under monitored
conditions after a settlement
D. To mandate criminal prosecution of compliance officers
E. To require hospitals to hire external auditors permanently
CORRECT ANSWER: C — To allow providers to continue participating in
federal programs under monitored conditions after a settlement
RATIONALE: A Corporate Integrity Agreement (CIA) is a formal agreement between the
OIG and a healthcare organization that has been found to have committed fraud or
other compliance violations. Rather than excluding the organization from
Medicare/Medicaid entirely, the OIG negotiates a CIA that allows continued participation
under strict conditions, including independent review organizations (IROs), mandatory
training, regular reporting, and other oversight obligations. CIAs typically last 5 years
and are publicly available on the OIG website.
Question 7 Which of the following is NOT one of the three "legs" of the healthcare
compliance triad?
A. Regulatory compliance
B. Privacy compliance
C. Financial compliance
D. Quality compliance
E. Ethics and conduct
CORRECT ANSWER: C — Financial compliance
RATIONALE: The healthcare compliance "triad" refers to the three primary domains: (1)
Regulatory/Legal Compliance (adherence to laws and regulations), (2) Privacy
Compliance (HIPAA and related privacy laws), and (3) Ethics and Standards of
Conduct. While financial compliance is critically important, it falls under regulatory
compliance rather than being a separate "leg" of the triad. Understanding this
framework helps compliance officers structure their programs effectively across all
organizational risk areas.
Question 8 The OIG's Work Plan is important to compliance officers because it:
A. Lists all hospitals excluded from Medicare
Questions & Verified Answers | Latest Just
Released Test Bank + Complete Study Guide
HCCA CHC/CHPC COMPLIANCE EXAM 2026
Questions — Complete Study Bank with Verified Answers
Question 1 What are the Seven Elements of an Effective Compliance Program as
outlined by the OIG?
A. Policies, Auditing, Training, Reporting, Investigations, Discipline, Response
B. Leadership, Policies, Training, Monitoring, Reporting, Enforcement, Response
C. Written standards, Compliance leadership, Training, Communication,
Monitoring/auditing, Enforcement/discipline, Response/prevention
D. Governance, Policies, Education, Hotlines, Auditing, Sanctions, Corrective Action
E. Oversight, Documentation, Communication, Risk Management, Audits, Ethics,
Feedback
CORRECT ANSWER: C — Written standards, Compliance leadership, Training,
Communication, Monitoring/auditing, Enforcement/discipline,
Response/prevention
RATIONALE: The OIG's Compliance Program Guidance identifies seven core elements
every effective healthcare compliance program must include. These are: (1) Written
Policies and Procedures, (2) Compliance Officer and Compliance Committee, (3)
Education and Training, (4) Effective Lines of Communication, (5) Monitoring and
Auditing, (6) Enforcement/Discipline, and (7) Response/Correction. These elements
form the backbone of any OIG-recognized compliance framework and are tested heavily
on the CHC exam.
Question 2 Which federal agency issues Compliance Program Guidance documents
for healthcare organizations?
A. Centers for Medicare and Medicaid Services (CMS)
B. Department of Justice (DOJ)
C. Office of Inspector General (OIG)
, D. Office for Civil Rights (OCR)
E. Federal Bureau of Investigation (FBI)
CORRECT ANSWER: C — Office of Inspector General (OIG)
RATIONALE: The OIG, under the U.S. Department of Health and Human Services
(HHS), is the primary agency that issues Compliance Program Guidance (CPG)
documents tailored to specific segments of the healthcare industry, including hospitals,
nursing facilities, third-party billers, and others. The OIG's mission includes detecting
and preventing fraud, waste, and abuse in federal healthcare programs, and its CPGs
serve as voluntary roadmaps for building effective compliance programs.
Question 3 The False Claims Act (FCA) imposes civil penalties for each false claim
submitted to the federal government. What is the approximate per-claim penalty range
as of recent updates?
A. $1,000 – $5,000
B. $5,000 – $10,000
C. $13,000 – $27,000
D. $50,000 – $100,000
E. $100,000 – $250,000
CORRECT ANSWER: C — $13,000 – $27,000
RATIONALE: The False Claims Act (31 U.S.C. § 3729) is the primary tool the
government uses to combat fraud in federal healthcare programs. Civil penalties are
adjusted annually for inflation. As of recent updates, penalties range from approximately
$13,946 to $27,894 per false claim, plus treble (triple) damages. This makes FCA
liability potentially enormous for providers who submit large volumes of fraudulent
claims. CHC candidates must know both the penalty structure and the key provisions of
the FCA.
Question 4 Under the False Claims Act, what is the term for a private individual who
files a lawsuit on behalf of the government?
A. Complainant
B. Whistleblower
, C. Qui Tam Relator
D. Informant
E. Respondent
CORRECT ANSWER: C — Qui Tam Relator
RATIONALE: The False Claims Act contains a "qui tam" provision (Latin: "who as well")
that allows private individuals, known as "relators," to file lawsuits on behalf of the
government against those who have defrauded federal programs. Relators are entitled
to receive between 15–30% of any recovered funds, depending on whether the
government intervenes. This provision has been responsible for recovering billions of
dollars in healthcare fraud. Compliance officers must understand this mechanism as it
directly affects organizational risk.
Question 5 Which of the following best defines "fraud" in the context of healthcare
compliance?
A. An unintentional billing error resulting in overpayment
B. A negligent mistake in clinical documentation
C. An intentional deception or misrepresentation to obtain unauthorized benefit
D. A systemic pattern of minor coding errors
E. Failure to update compliance policies annually
CORRECT ANSWER: C — An intentional deception or misrepresentation to
obtain unauthorized benefit
RATIONALE: Healthcare fraud is defined as an intentional act of deception,
misrepresentation, or concealment of material facts to obtain money or benefits to which
one is not entitled. This distinguishes fraud from "abuse," which refers to practices that
are inconsistent with sound medical or business practices but may not involve
intentional deception. Understanding the distinction between fraud, waste, and abuse
(FWA) is fundamental to compliance work and is heavily tested on the CHC exam.
Question 6 What is the primary purpose of a Corporate Integrity Agreement (CIA)?
A. To fine healthcare organizations for billing errors
B. To permanently exclude providers from Medicare and Medicaid
, C. To allow providers to continue participating in federal programs under monitored
conditions after a settlement
D. To mandate criminal prosecution of compliance officers
E. To require hospitals to hire external auditors permanently
CORRECT ANSWER: C — To allow providers to continue participating in
federal programs under monitored conditions after a settlement
RATIONALE: A Corporate Integrity Agreement (CIA) is a formal agreement between the
OIG and a healthcare organization that has been found to have committed fraud or
other compliance violations. Rather than excluding the organization from
Medicare/Medicaid entirely, the OIG negotiates a CIA that allows continued participation
under strict conditions, including independent review organizations (IROs), mandatory
training, regular reporting, and other oversight obligations. CIAs typically last 5 years
and are publicly available on the OIG website.
Question 7 Which of the following is NOT one of the three "legs" of the healthcare
compliance triad?
A. Regulatory compliance
B. Privacy compliance
C. Financial compliance
D. Quality compliance
E. Ethics and conduct
CORRECT ANSWER: C — Financial compliance
RATIONALE: The healthcare compliance "triad" refers to the three primary domains: (1)
Regulatory/Legal Compliance (adherence to laws and regulations), (2) Privacy
Compliance (HIPAA and related privacy laws), and (3) Ethics and Standards of
Conduct. While financial compliance is critically important, it falls under regulatory
compliance rather than being a separate "leg" of the triad. Understanding this
framework helps compliance officers structure their programs effectively across all
organizational risk areas.
Question 8 The OIG's Work Plan is important to compliance officers because it:
A. Lists all hospitals excluded from Medicare
