CPCO All-in-One Bundle – Healthcare --- --- --- --- ---
Compliance, HIPAA, Fraud & Abuse --- --- --- --- ---
Questions with Detailed Rationales Exam --- --- --- --- ---
Questions & Answers for 2026/2027 --- --- --- --- ---
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SECTION 1: COMPLIANCE PROGRAM ESSENTIALS & OIG 7 CORE
--- --- --- --- --- --- --- --- ---
ELEMENTS ---
Question 1 --- ---
Under Public Law 104-191, the Health Insurance Portability and Accountability
--- --- --- --- --- --- --- --- --- ---
Act of 1996 (HIPAA), what is the name of the national program designed to
--- --- --- --- --- --- --- --- --- --- --- --- --- ---
coordinate Federal, State and local law enforcement activities with respect to
--- --- --- --- --- --- --- --- --- --- ---
health care fraud and abuse?
--- --- --- --- ---
A) Medicare Fraud Strike Force --- --- --- ---
B) Health Care Fraud and Abuse Control Program (HCFAC)
--- --- --- --- --- --- --- ---
C) Office of Inspector General Enforcement Division
--- --- --- --- --- ---
D) Federal Health Care Anti-Fraud Task Force
--- --- --- --- --- ---
Answer: B --- ---
Rationale: HIPAA established the Health Care Fraud and Abuse Control
--- --- --- --- --- --- --- --- --- ---
Program (HCFAC) to combat fraud through coordinated efforts between the
--- --- --- --- --- --- --- --- --- ---
OIG, DOJ, and other federal and state law enforcement agencies .
--- --- --- --- --- --- --- --- --- --- ---
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Question 2 --- ---
According to the Federal Sentencing Guidelines, "To have an effective
--- --- --- --- --- --- --- --- --- ---
compliance and ethics program..., an organization shall exercise due diligence
--- --- --- --- --- --- --- --- --- ---
to prevent and detect criminal conduct." The FSGs also state organizations
--- --- --- --- --- --- --- --- --- --- ---
shall: ---
A) Focus only on financial compliance
--- --- --- --- ---
,B) Promote an organizational culture that encourages ethical conduct and a
--- --- --- --- --- --- --- --- --- ---
commitment to compliance with the law --- --- --- --- --- ---
C) Outsource all compliance activities to external consultants
--- --- --- --- --- --- ---
D) Limit compliance training to executive leadership only
--- --- --- --- --- --- ---
Answer: B --- ---
Rationale: The Federal Sentencing Guidelines require organizations to
--- --- --- --- --- --- --- ---
promote a --- ---
culture of ethics and compliance throughout the organization, not just focus
--- --- --- --- --- --- --- --- --- --- ---
on financial metrics .
--- --- --- ---
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Question 3 --- ---
The OIG has described seven basic components of an effective compliance
--- --- --- --- --- --- --- --- --- --- ---
program. These are based on which of the following?
--- --- --- --- --- --- --- --- ---
A) The Affordable Care Act
--- --- --- ---
B) The Federal Sentencing Guidelines for Organizations (FSGO)
--- --- --- --- --- --- ---
C) The Health Insurance Portability and Accountability Act (HIPAA)
--- --- --- --- --- --- --- ---
D) The Medicare Conditions of Participation
--- --- --- --- ---
Answer: B --- ---
Rationale: The FSGO codified the "Seven Essential Elements" of an effective
--- --- --- --- --- --- --- --- --- --- ---
compliance and ethics program, which the OIG adopted as the foundation for its
--- --- --- --- --- --- --- --- --- --- --- --- --
healthcare industry compliance guidance .
- --- --- --- --- ---
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Question 4 --- ---
Which of the following is NOT one of the OIG's 7 Core Elements for an
--- --- --- --- --- --- --- --- --- --- --- --- --- --- ---
effective compliance program?
--- --- ---
A) Designation of a compliance officer and committee --- --- --- --- --- --- ---
B) Conducting internal monitoring and auditing --- --- --- --- ---
C) Mandatory external financial audits --- --- --- ---
D) Responding to detected offenses and developing corrective actions
--- --- --- --- --- --- --- ---
,Answer: C --- ---
Rationale: External financial audits are not among the 7 Core Elements. The
--- --- --- --- --- --- --- --- --- --- --- ---
seven elements include written policies, a compliance officer, training, open
--- --- --- --- --- --- --- --- --- ---
communication, internal auditing/monitoring, enforcement, and corrective action
--- --- --- --- --- --- ---
.
---
--
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Question 5 --- ---
What is the ultimate goal of ongoing auditing and monitoring within a
--- --- --- --- --- --- --- --- --- --- --- ---
physician practice? --- ---
A) To prevent all fraud
--- --- --- ---
B) To enhance revenues by detecting undercoding
--- --- --- --- --- ---
C) To evaluate whether the practice's standards are current and if the
--- --- --- --- --- --- --- --- --- --- ---
compliance program is functioning effectively --- --- --- --- ---
D) To outline the official coding guidelines for hospitals
--- --- --- --- --- --- --- ---
Answer: C --- ---
Rationale: The goal of ongoing auditing and monitoring is to evaluate whether
--- --- --- --- --- --- --- --- --- --- --- ---
the physician practice's standards and procedures are current and accurate and
--- --- --- --- --- --- --- --- --- --- ---
whether the compliance program is working effectively .
--- --- --- --- --- --- --- ---
--
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Question 6 --- ---
A compliance program's plan for communication should include a provision for
--- --- --- --- --- --- --- --- --- --- ---
non-retaliation for reporting fraudulent conduct. Which method below helps
--- --- --- --- --- --- --- --- ---
ensure that an employee would be free from retribution?
--- --- --- --- --- --- --- --- ---
A) A clearly defined chain of command for reporting potentially fraudulent
--- --- --- --- --- --- --- --- --- ---
conduct ---
B) Guaranteed anonymity --- ---
C) Well-publicized disciplinary actions for retaliation --- --- --- --- ---
D) A policy that encourages reporting directly to the OIG
--- --- --- --- --- --- --- --- ---
Answer: C --- ---
Rationale: Publicizing disciplinary actions for retaliation demonstrates the
--- --- --- --- --- --- --- ---
organization's commitment to protecting whistleblowers and deters retaliatory
--- --- --- --- --- --- --- ---
behavior . --- ---
, --
-
Question 7 --- ---
What does the HHS OIG suggest as possible warning signs that non-compliance
--- --- --- --- --- --- --- --- --- --- --- -
may exist?
-- --- ---
A) Increased patient satisfaction scores --- --- --- ---
B) Significant change in the number or type of claim rejections
--- --- --- --- --- --- --- --- --- ---
C) Higher than average employee retention
--- --- --- --- ---
D) Decreased number of patient complaints --- --- --- --- ---
Answer: B --- ---
Rationale: Significant changes in claim rejection patterns can indicate
--- --- --- --- --- --- --- --- ---
underlying compliance issues such as coding errors, documentation problems, or
--- --- --- --- --- --- --- --- --- -
improper billing practices .
-- --- --- --- ---
--
-
Question 8 --- ---
Having the ability to respond to issues enables a practice to develop effective
--- --- --- --- --- --- --- --- --- --- --- --- ---
action plans. What is one step that can be taken to establish compliance
--- --- --- --- --- --- --- --- --- --- --- --- ---
effectiveness for the response/prevention element? --- --- --- --- ---
A) Wait for the OIG to identify issues before acting
--- --- --- --- --- --- --- --- ---
B) Create a response team consisting of representatives from compliance, audit,
--- --- --- --- --- --- --- --- --- ---
and any other relevant functional departments
--- --- --- --- --- ---
C) Assign all response responsibilities to a single individual
--- --- --- --- --- --- --- ---
D) Focus only on issues that have already resulted in overpayments
--- --- --- --- --- --- --- --- --- ---
Answer: B --- ---
Rationale: A cross-functional response team enables comprehensive
--- --- --- --- --- --- ---
investigation and corrective action planning, drawing on expertise from multiple
--- --- --- --- --- --- --- --- --- --
departments .
- --- ---
--
-
Question 9 --- ---
Developing effective compliance policies and procedures is an important part of
--- --- --- --- --- --- --- --- --- --- --
any compliance program. To help your practice mitigate compliance risk,
- --- --- --- --- --- --- --- --- --- ---
policies and procedures should:
--- --- --- ---
Compliance, HIPAA, Fraud & Abuse --- --- --- --- ---
Questions with Detailed Rationales Exam --- --- --- --- ---
Questions & Answers for 2026/2027 --- --- --- --- ---
--
-
SECTION 1: COMPLIANCE PROGRAM ESSENTIALS & OIG 7 CORE
--- --- --- --- --- --- --- --- ---
ELEMENTS ---
Question 1 --- ---
Under Public Law 104-191, the Health Insurance Portability and Accountability
--- --- --- --- --- --- --- --- --- ---
Act of 1996 (HIPAA), what is the name of the national program designed to
--- --- --- --- --- --- --- --- --- --- --- --- --- ---
coordinate Federal, State and local law enforcement activities with respect to
--- --- --- --- --- --- --- --- --- --- ---
health care fraud and abuse?
--- --- --- --- ---
A) Medicare Fraud Strike Force --- --- --- ---
B) Health Care Fraud and Abuse Control Program (HCFAC)
--- --- --- --- --- --- --- ---
C) Office of Inspector General Enforcement Division
--- --- --- --- --- ---
D) Federal Health Care Anti-Fraud Task Force
--- --- --- --- --- ---
Answer: B --- ---
Rationale: HIPAA established the Health Care Fraud and Abuse Control
--- --- --- --- --- --- --- --- --- ---
Program (HCFAC) to combat fraud through coordinated efforts between the
--- --- --- --- --- --- --- --- --- ---
OIG, DOJ, and other federal and state law enforcement agencies .
--- --- --- --- --- --- --- --- --- --- ---
--
-
Question 2 --- ---
According to the Federal Sentencing Guidelines, "To have an effective
--- --- --- --- --- --- --- --- --- ---
compliance and ethics program..., an organization shall exercise due diligence
--- --- --- --- --- --- --- --- --- ---
to prevent and detect criminal conduct." The FSGs also state organizations
--- --- --- --- --- --- --- --- --- --- ---
shall: ---
A) Focus only on financial compliance
--- --- --- --- ---
,B) Promote an organizational culture that encourages ethical conduct and a
--- --- --- --- --- --- --- --- --- ---
commitment to compliance with the law --- --- --- --- --- ---
C) Outsource all compliance activities to external consultants
--- --- --- --- --- --- ---
D) Limit compliance training to executive leadership only
--- --- --- --- --- --- ---
Answer: B --- ---
Rationale: The Federal Sentencing Guidelines require organizations to
--- --- --- --- --- --- --- ---
promote a --- ---
culture of ethics and compliance throughout the organization, not just focus
--- --- --- --- --- --- --- --- --- --- ---
on financial metrics .
--- --- --- ---
--
-
Question 3 --- ---
The OIG has described seven basic components of an effective compliance
--- --- --- --- --- --- --- --- --- --- ---
program. These are based on which of the following?
--- --- --- --- --- --- --- --- ---
A) The Affordable Care Act
--- --- --- ---
B) The Federal Sentencing Guidelines for Organizations (FSGO)
--- --- --- --- --- --- ---
C) The Health Insurance Portability and Accountability Act (HIPAA)
--- --- --- --- --- --- --- ---
D) The Medicare Conditions of Participation
--- --- --- --- ---
Answer: B --- ---
Rationale: The FSGO codified the "Seven Essential Elements" of an effective
--- --- --- --- --- --- --- --- --- --- ---
compliance and ethics program, which the OIG adopted as the foundation for its
--- --- --- --- --- --- --- --- --- --- --- --- --
healthcare industry compliance guidance .
- --- --- --- --- ---
--
-
Question 4 --- ---
Which of the following is NOT one of the OIG's 7 Core Elements for an
--- --- --- --- --- --- --- --- --- --- --- --- --- --- ---
effective compliance program?
--- --- ---
A) Designation of a compliance officer and committee --- --- --- --- --- --- ---
B) Conducting internal monitoring and auditing --- --- --- --- ---
C) Mandatory external financial audits --- --- --- ---
D) Responding to detected offenses and developing corrective actions
--- --- --- --- --- --- --- ---
,Answer: C --- ---
Rationale: External financial audits are not among the 7 Core Elements. The
--- --- --- --- --- --- --- --- --- --- --- ---
seven elements include written policies, a compliance officer, training, open
--- --- --- --- --- --- --- --- --- ---
communication, internal auditing/monitoring, enforcement, and corrective action
--- --- --- --- --- --- ---
.
---
--
-
Question 5 --- ---
What is the ultimate goal of ongoing auditing and monitoring within a
--- --- --- --- --- --- --- --- --- --- --- ---
physician practice? --- ---
A) To prevent all fraud
--- --- --- ---
B) To enhance revenues by detecting undercoding
--- --- --- --- --- ---
C) To evaluate whether the practice's standards are current and if the
--- --- --- --- --- --- --- --- --- --- ---
compliance program is functioning effectively --- --- --- --- ---
D) To outline the official coding guidelines for hospitals
--- --- --- --- --- --- --- ---
Answer: C --- ---
Rationale: The goal of ongoing auditing and monitoring is to evaluate whether
--- --- --- --- --- --- --- --- --- --- --- ---
the physician practice's standards and procedures are current and accurate and
--- --- --- --- --- --- --- --- --- --- ---
whether the compliance program is working effectively .
--- --- --- --- --- --- --- ---
--
-
Question 6 --- ---
A compliance program's plan for communication should include a provision for
--- --- --- --- --- --- --- --- --- --- ---
non-retaliation for reporting fraudulent conduct. Which method below helps
--- --- --- --- --- --- --- --- ---
ensure that an employee would be free from retribution?
--- --- --- --- --- --- --- --- ---
A) A clearly defined chain of command for reporting potentially fraudulent
--- --- --- --- --- --- --- --- --- ---
conduct ---
B) Guaranteed anonymity --- ---
C) Well-publicized disciplinary actions for retaliation --- --- --- --- ---
D) A policy that encourages reporting directly to the OIG
--- --- --- --- --- --- --- --- ---
Answer: C --- ---
Rationale: Publicizing disciplinary actions for retaliation demonstrates the
--- --- --- --- --- --- --- ---
organization's commitment to protecting whistleblowers and deters retaliatory
--- --- --- --- --- --- --- ---
behavior . --- ---
, --
-
Question 7 --- ---
What does the HHS OIG suggest as possible warning signs that non-compliance
--- --- --- --- --- --- --- --- --- --- --- -
may exist?
-- --- ---
A) Increased patient satisfaction scores --- --- --- ---
B) Significant change in the number or type of claim rejections
--- --- --- --- --- --- --- --- --- ---
C) Higher than average employee retention
--- --- --- --- ---
D) Decreased number of patient complaints --- --- --- --- ---
Answer: B --- ---
Rationale: Significant changes in claim rejection patterns can indicate
--- --- --- --- --- --- --- --- ---
underlying compliance issues such as coding errors, documentation problems, or
--- --- --- --- --- --- --- --- --- -
improper billing practices .
-- --- --- --- ---
--
-
Question 8 --- ---
Having the ability to respond to issues enables a practice to develop effective
--- --- --- --- --- --- --- --- --- --- --- --- ---
action plans. What is one step that can be taken to establish compliance
--- --- --- --- --- --- --- --- --- --- --- --- ---
effectiveness for the response/prevention element? --- --- --- --- ---
A) Wait for the OIG to identify issues before acting
--- --- --- --- --- --- --- --- ---
B) Create a response team consisting of representatives from compliance, audit,
--- --- --- --- --- --- --- --- --- ---
and any other relevant functional departments
--- --- --- --- --- ---
C) Assign all response responsibilities to a single individual
--- --- --- --- --- --- --- ---
D) Focus only on issues that have already resulted in overpayments
--- --- --- --- --- --- --- --- --- ---
Answer: B --- ---
Rationale: A cross-functional response team enables comprehensive
--- --- --- --- --- --- ---
investigation and corrective action planning, drawing on expertise from multiple
--- --- --- --- --- --- --- --- --- --
departments .
- --- ---
--
-
Question 9 --- ---
Developing effective compliance policies and procedures is an important part of
--- --- --- --- --- --- --- --- --- --- --
any compliance program. To help your practice mitigate compliance risk,
- --- --- --- --- --- --- --- --- --- ---
policies and procedures should:
--- --- --- ---
