CERTIFIED HEALTHCARE
COMPLIANCE - CCB EXAM 2024
QUESTIONS AND ANSWERS WITH
SOLUTIONS 2024
EEOC - ANSWER Equal Employment Opportunity Commission - employment and labor laws.
ERISA - ANSWER Employee Retirement Income Security Act - regulations, wage and hours rules.
OSHA - ANSWER Occupational Safety and Health Administration - Nuclear regulatory commission.
JCAHO - ANSWER Joint Commission on Accreditation of Healthcare Organizations
What is a compliance program - ANSWER prevent, detect, collaborate and enforce.
OIG - ANSWER Office of Inspector General - enforces rules and regulations under that Medicare and
Medicaid laws.
AG - ANSWER Attorney General
Benefits of a Compliance Program - ANSWER 1. Demonstrate to employees and the community the org
commitment to good conduct.
2. ID and prevent criminal and unethical conduct.
3. Improve the quality of patient care.
4. Create a centralized source of information on health care regulations.
5. Develop a methodology that encourages employees to report potential probs.
6. Develop procedures that allow the prompt, thorough investigation of alleged misconduct.
7. Initiate immediate and appropriate corrective action.
8. Reduce the orgs exposure to civil damages and penalties, criminal sanctions, and administrative
remedies.
,CIA - ANSWER Corporate Integrity Agreement
Reasons to Implement CRP - ANSWER 1. demonstrates to community that provider has a strong
commitment to honesty and responsible corporate citizenship.
2. reinforce employees' innate sense of right and wrong.
3. Helps provider fulfill its legal duty to govt and private payors.
4. Cost effective in the long run.
5. More accurate view of employee and contractor behavior relating to fraud and abuse.
6. Enhanced quality of patient care.
7. Provides procedures to promptly correct misconduct.
8. Mitigate any sanctions imposed by the govt.
9. Voluntarily implementing is better than govt imposed any day!
10. May protect corporate directors from liability.
HIPAA - ANSWER Health Insurance Portability and Accountability Act of 1996 - criminal offense to submit
false claims. Also states we will protect patient information.
False Claims Act - ANSWER govt may investigate and bring civil action against providers found submitting
incorrect claims on purpose.
Whistle Blower - ANSWER Qui Tam
Federal Sentencing Guidelines - ANSWER guidance for assessing fines is designed so that sanctions
imposed upon orgs and their ages, will provide just punishment, adequate deterrence and incentive for
orgs to take action.
Culpability Score - ANSWER Calculation of fines that adds points for aggravating factors and subtracts
points for mitigating factors.
, Culpability Score Aggravating Factors - ANSWER 1. upper level employee has participated in, condoned
or willfully ignorant of the offense.
2. violation is a repeat offense.
3. govt was hindered during investigation.
4. awareness of and tolerance of violation were pervasive.
Culpability Score Mitigating Factors - ANSWER 1. org have an effective CRP
2. org reported the violation promptly
3. org cooperated w/govt investigation
4. org accepted responsibility.
Seven Elements of CRP - ANSWER 1. Written standards of conduct
2. Designated a chief compliance officer
3. effective education and training
4. audits/evaluation techniques to monitor compliance.
5. reporting process/procedures for complaints.
6. appropriate disciplinary mechanisms
7. investigation and remediation of systemic problems.
10 Obstacles of Effective Implementation - ANSWER 1. commitment and buy in
2. funding
3. too many hats to be worn by individual(s)
4. interpreting laws and regulations
5. lack of resources/ staff
6. lack of education and training
7. resistance to change
8. lack of/poor communication
9. fear of retaliation/retribution
10. no internal enforcement.
COMPLIANCE - CCB EXAM 2024
QUESTIONS AND ANSWERS WITH
SOLUTIONS 2024
EEOC - ANSWER Equal Employment Opportunity Commission - employment and labor laws.
ERISA - ANSWER Employee Retirement Income Security Act - regulations, wage and hours rules.
OSHA - ANSWER Occupational Safety and Health Administration - Nuclear regulatory commission.
JCAHO - ANSWER Joint Commission on Accreditation of Healthcare Organizations
What is a compliance program - ANSWER prevent, detect, collaborate and enforce.
OIG - ANSWER Office of Inspector General - enforces rules and regulations under that Medicare and
Medicaid laws.
AG - ANSWER Attorney General
Benefits of a Compliance Program - ANSWER 1. Demonstrate to employees and the community the org
commitment to good conduct.
2. ID and prevent criminal and unethical conduct.
3. Improve the quality of patient care.
4. Create a centralized source of information on health care regulations.
5. Develop a methodology that encourages employees to report potential probs.
6. Develop procedures that allow the prompt, thorough investigation of alleged misconduct.
7. Initiate immediate and appropriate corrective action.
8. Reduce the orgs exposure to civil damages and penalties, criminal sanctions, and administrative
remedies.
,CIA - ANSWER Corporate Integrity Agreement
Reasons to Implement CRP - ANSWER 1. demonstrates to community that provider has a strong
commitment to honesty and responsible corporate citizenship.
2. reinforce employees' innate sense of right and wrong.
3. Helps provider fulfill its legal duty to govt and private payors.
4. Cost effective in the long run.
5. More accurate view of employee and contractor behavior relating to fraud and abuse.
6. Enhanced quality of patient care.
7. Provides procedures to promptly correct misconduct.
8. Mitigate any sanctions imposed by the govt.
9. Voluntarily implementing is better than govt imposed any day!
10. May protect corporate directors from liability.
HIPAA - ANSWER Health Insurance Portability and Accountability Act of 1996 - criminal offense to submit
false claims. Also states we will protect patient information.
False Claims Act - ANSWER govt may investigate and bring civil action against providers found submitting
incorrect claims on purpose.
Whistle Blower - ANSWER Qui Tam
Federal Sentencing Guidelines - ANSWER guidance for assessing fines is designed so that sanctions
imposed upon orgs and their ages, will provide just punishment, adequate deterrence and incentive for
orgs to take action.
Culpability Score - ANSWER Calculation of fines that adds points for aggravating factors and subtracts
points for mitigating factors.
, Culpability Score Aggravating Factors - ANSWER 1. upper level employee has participated in, condoned
or willfully ignorant of the offense.
2. violation is a repeat offense.
3. govt was hindered during investigation.
4. awareness of and tolerance of violation were pervasive.
Culpability Score Mitigating Factors - ANSWER 1. org have an effective CRP
2. org reported the violation promptly
3. org cooperated w/govt investigation
4. org accepted responsibility.
Seven Elements of CRP - ANSWER 1. Written standards of conduct
2. Designated a chief compliance officer
3. effective education and training
4. audits/evaluation techniques to monitor compliance.
5. reporting process/procedures for complaints.
6. appropriate disciplinary mechanisms
7. investigation and remediation of systemic problems.
10 Obstacles of Effective Implementation - ANSWER 1. commitment and buy in
2. funding
3. too many hats to be worn by individual(s)
4. interpreting laws and regulations
5. lack of resources/ staff
6. lack of education and training
7. resistance to change
8. lack of/poor communication
9. fear of retaliation/retribution
10. no internal enforcement.
