COMPLIANCE 101 EXAM 2025
COMPLIANCE 101 EXAM 2025 QUESTIONS AND
ANSWERS GRADED A+
What does the compliance program consist of?
prevention, detection, collaboration, and enforcement
Effective compliance program
must be an ongoing process and commitment to an ethical way of conducting
business
Office of Inspector General and Justice Department
is responsible for enforcing the rules and regulations under the Medicare and
Medicaid laws outline as part of the SSA by CMS.
Benefits of compliance program addressed by OIG
safeguards the organizations' legal responsibility to abide by applicable laws and
regulations.
,COMPLIANCE 101 EXAM 2025
Corporate Integrity Agreement (CIA)
government imposed compliance program
Why compliance programs are essential
prevent paybacks, probation, government designed programs, exclusion, reduce
threat of lawsuits from whistleblowers (qui tam).
OIG Top 10 reasons to implement a compliance program
demonstrates a strong commitment to honesty and responsible corporate relations,
reinforces employees sense of right and wrong, fulfill legal duty to payers, cost
effective, more accurate view of what is going on, quality of care to clients,
provides procedures to promptly correct misconduct, mitigate any sanction
imposed by government.
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
a criminal offense to submit claims based on incorrect codes or medically
unnecessary services, and government has the power to exclude an organization
from Medicare/caid and other govt programs.
Balanced Budget Act of 1997
, COMPLIANCE 101 EXAM 2025
three strikes and your out clause , requiring permanent expulsion if found guilty of
fraud a third time.
False Claims Act (FCA)
empowers the govt to investigate and bring civil action in fraud cases.
Implemented in Civil War to control price gouging.
Qui tam
is a whistleblower who brings the fraud to light.
A whistleblower can receive a % of the govt's total award
15-25% if DOJ assumes the case or 25-30% if DOJ declines
To avoid lengthy and expensive litigation, an organization can negotiate a
____________with the govt admits no fault or liability but does submit to a govt
plan for corrective action.
CIA
Length of CIAs
COMPLIANCE 101 EXAM 2025 QUESTIONS AND
ANSWERS GRADED A+
What does the compliance program consist of?
prevention, detection, collaboration, and enforcement
Effective compliance program
must be an ongoing process and commitment to an ethical way of conducting
business
Office of Inspector General and Justice Department
is responsible for enforcing the rules and regulations under the Medicare and
Medicaid laws outline as part of the SSA by CMS.
Benefits of compliance program addressed by OIG
safeguards the organizations' legal responsibility to abide by applicable laws and
regulations.
,COMPLIANCE 101 EXAM 2025
Corporate Integrity Agreement (CIA)
government imposed compliance program
Why compliance programs are essential
prevent paybacks, probation, government designed programs, exclusion, reduce
threat of lawsuits from whistleblowers (qui tam).
OIG Top 10 reasons to implement a compliance program
demonstrates a strong commitment to honesty and responsible corporate relations,
reinforces employees sense of right and wrong, fulfill legal duty to payers, cost
effective, more accurate view of what is going on, quality of care to clients,
provides procedures to promptly correct misconduct, mitigate any sanction
imposed by government.
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
a criminal offense to submit claims based on incorrect codes or medically
unnecessary services, and government has the power to exclude an organization
from Medicare/caid and other govt programs.
Balanced Budget Act of 1997
, COMPLIANCE 101 EXAM 2025
three strikes and your out clause , requiring permanent expulsion if found guilty of
fraud a third time.
False Claims Act (FCA)
empowers the govt to investigate and bring civil action in fraud cases.
Implemented in Civil War to control price gouging.
Qui tam
is a whistleblower who brings the fraud to light.
A whistleblower can receive a % of the govt's total award
15-25% if DOJ assumes the case or 25-30% if DOJ declines
To avoid lengthy and expensive litigation, an organization can negotiate a
____________with the govt admits no fault or liability but does submit to a govt
plan for corrective action.
CIA
Length of CIAs
