CPCO STUDY GUIDE EXAM 2025
QUESTIONS AND ANSWERS
One of the most important elements of an effective compliance program is to have a
compliance officer or committee who is__________. - ANS empowered
If an employee, provider or anyone that deals with Federal or State healthcare dollars has
intent to receive payment for services not legitimately rendered this is considered
______________? - ANS fraud
Joan, as an employee of a healthcare organization, has _________to report erroneous conduct,
without repercussions, so that it may be corrected immediately - ANS duty
person who exposes misconduct, alleged dishonest or illegal activity occurring in an
organization is called a______________? - ANS relator
The compliance program will flounder if employees of the organization are not aware of
_________? - ANS laws and regulations that pertain to their specific job descriptions
When physicians (or their staff) make billing mistakes and errors the most important thing to do
is _________? - ANS Send a refund
Judy is the Compliance Officer for Apple Medical Group. The practice is a small group of
providers. Judy wants to have an open door policy as suggested by the OIG, thus she will? -
1
ANS Post notices of up-to-date compliance information on the employee bulletin board
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@COPYRIGHT SIRJOEL 2025/2026
, Participants in the Federal healthcare programs have an obligation to take measures, such as
instituting a compliance program, to _________________? - ANS detects and prevent
fraudulent, abusive and wasteful activities
Tim, the Compliance Officer for XYZ Community Hospital, should report to whom? - ANS CEO
or Board
The biller at XYZ Community Hospital wants to win the award every month for posting the most
insurance checks. Instead of giving the claims 30-60 days to clear, she bills them again at the
end of the month. This is an example of? - ANS double billing
The OIG has described seven basic components of an effective compliance program for a small
physician practice that are based from the _______________? - ANS Federal Sentencing
Guidelines
Kim, Compliance Officer for ABC Provider Group, created a compliance plan and policy a year
ago. While reviewing the groups Baseline Audits it comes to her attention that many of the staff
have decided NOT to follow the compliance plan. The Non-Compliance has ____________? -
ANS created a big risk of the group and Kim needs to make sure that everyone knows about
the risk of not following the compliance plan
A high-level statement or plan that embraces an organization's general beliefs, goals, objectives
and acceptable procedure for a specified subject area is a _______________? - ANS policy
Kim is the Compliance Officer for ABC Provider Group. Kim has read the OIG Compliance
Program Guidance that acknowledges patient care as the first priority of a physician practice. As
the Compliance Officer (CO), Kim should implement what type of compliance model? - ANS A
"patients first"
It is important to educate employees of the methods they may utilize to directly notify and
2
communicate issues of suspected areas of non-compliance. What is considered a best practice
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method of anonymous reporting? - ANS intra-office or USPS mail
@COPYRIGHT SIRJOEL 2025/2026
, Tim at XYZ wants to conduct a baseline audit to help determine? - ANS areas of the billing
department that might be in compliance
When the term Open Door Policy is used in reference to the Effective Communication, what is
this referring to? - ANS The Compliance Officer is accessible to all employees via many
methods of communication
When Kim from ABC Provider Group is conducting a risk assessment, one of the most important
and key sources of information that Kim as the Compliance Officer should utilize
is_____________. - ANS the Office of Inspector General's Annual Work Plan
The mission statement of the healthcare organization and a statement of why they are in
business are also known as _________? - ANS The Code of conduct
How often should the Tim, Compliance Officer for XYZ Community Hospital update the
compliance program and plan? - ANS As laws and regulations change; and at least annually
After an employee receives their initial training regarding the practice/organization Compliance
Program what is the next step the compliance officer should take to protect the practice against
potential noncompliance activity? - ANS Perform a baseline assessment of the employee's
competency scores to determine if additional training is required
ABC Provider Group and Apple Medical Group agree to pool their resources for the purpose of
accomplishing a specific task. This is called _____________. - ANS Joint ventures
The following is not a level of non-compliance: - ANS Mistake in billing
For potential criminal violations, a practice should have immediate discussions with a criminal
attorney who - ANS Is well versed in Healthcare Fraud and Abuse law
3
Page
@COPYRIGHT SIRJOEL 2025/2026
, The Compliance Officer's main two responsibilities are to ____________the
practice/organization's compliance program. - ANS develops and then implement
Judy is the Compliance Officer for Apple Medical Group. The providers of the group ask Judy to
design a new Compliance Plan. Should Judy ask some other practices in town for a copy of their
Compliance Plan? Do all Compliance Programs have to be the same regardless of the practice
size or specialty? Why? - ANS No, compliance programs need to be tailored to fit the unique
needs of every organization or physician practice
USSC is important as it related to the Federal Sentencing Guidelines and thus related to the
core elements of compliance. What does the USSC acronym stand for? - ANS United States
Sentencing Commission
Kathy, the Compliance Officer at a small provider office, is notified that a non-English speaking
patient will be arriving today. A LEP person/patient who needs an interpreter to translate to
and from the person's primary language must be provided. - ANS at no cost to the patient or
insurance carrier
In addition to hospitals, what other type of facility did the OIG provide supplemental
compliance program guidance for? - ANS Nursing Facilities
What is (are) considered a significant element(s) in fraud? - ANS Knowingly and Intent
Department of Labor requires compliance with employee and employer laws including: -
ANS FLSA, OSHA, CRA, ERISA
Which government branch was created to fight waste, fraud and abuse in all federal health care
programs especially Medicare, Medicaid? - ANS Office of Inspector General (OIG)
Dr. X is a very through provider. He always runs a full blood panel on each patient every year for
their physical. This is an example of: - ANS Waste
4
Page
@COPYRIGHT SIRJOEL 2025/2026
QUESTIONS AND ANSWERS
One of the most important elements of an effective compliance program is to have a
compliance officer or committee who is__________. - ANS empowered
If an employee, provider or anyone that deals with Federal or State healthcare dollars has
intent to receive payment for services not legitimately rendered this is considered
______________? - ANS fraud
Joan, as an employee of a healthcare organization, has _________to report erroneous conduct,
without repercussions, so that it may be corrected immediately - ANS duty
person who exposes misconduct, alleged dishonest or illegal activity occurring in an
organization is called a______________? - ANS relator
The compliance program will flounder if employees of the organization are not aware of
_________? - ANS laws and regulations that pertain to their specific job descriptions
When physicians (or their staff) make billing mistakes and errors the most important thing to do
is _________? - ANS Send a refund
Judy is the Compliance Officer for Apple Medical Group. The practice is a small group of
providers. Judy wants to have an open door policy as suggested by the OIG, thus she will? -
1
ANS Post notices of up-to-date compliance information on the employee bulletin board
Page
@COPYRIGHT SIRJOEL 2025/2026
, Participants in the Federal healthcare programs have an obligation to take measures, such as
instituting a compliance program, to _________________? - ANS detects and prevent
fraudulent, abusive and wasteful activities
Tim, the Compliance Officer for XYZ Community Hospital, should report to whom? - ANS CEO
or Board
The biller at XYZ Community Hospital wants to win the award every month for posting the most
insurance checks. Instead of giving the claims 30-60 days to clear, she bills them again at the
end of the month. This is an example of? - ANS double billing
The OIG has described seven basic components of an effective compliance program for a small
physician practice that are based from the _______________? - ANS Federal Sentencing
Guidelines
Kim, Compliance Officer for ABC Provider Group, created a compliance plan and policy a year
ago. While reviewing the groups Baseline Audits it comes to her attention that many of the staff
have decided NOT to follow the compliance plan. The Non-Compliance has ____________? -
ANS created a big risk of the group and Kim needs to make sure that everyone knows about
the risk of not following the compliance plan
A high-level statement or plan that embraces an organization's general beliefs, goals, objectives
and acceptable procedure for a specified subject area is a _______________? - ANS policy
Kim is the Compliance Officer for ABC Provider Group. Kim has read the OIG Compliance
Program Guidance that acknowledges patient care as the first priority of a physician practice. As
the Compliance Officer (CO), Kim should implement what type of compliance model? - ANS A
"patients first"
It is important to educate employees of the methods they may utilize to directly notify and
2
communicate issues of suspected areas of non-compliance. What is considered a best practice
Page
method of anonymous reporting? - ANS intra-office or USPS mail
@COPYRIGHT SIRJOEL 2025/2026
, Tim at XYZ wants to conduct a baseline audit to help determine? - ANS areas of the billing
department that might be in compliance
When the term Open Door Policy is used in reference to the Effective Communication, what is
this referring to? - ANS The Compliance Officer is accessible to all employees via many
methods of communication
When Kim from ABC Provider Group is conducting a risk assessment, one of the most important
and key sources of information that Kim as the Compliance Officer should utilize
is_____________. - ANS the Office of Inspector General's Annual Work Plan
The mission statement of the healthcare organization and a statement of why they are in
business are also known as _________? - ANS The Code of conduct
How often should the Tim, Compliance Officer for XYZ Community Hospital update the
compliance program and plan? - ANS As laws and regulations change; and at least annually
After an employee receives their initial training regarding the practice/organization Compliance
Program what is the next step the compliance officer should take to protect the practice against
potential noncompliance activity? - ANS Perform a baseline assessment of the employee's
competency scores to determine if additional training is required
ABC Provider Group and Apple Medical Group agree to pool their resources for the purpose of
accomplishing a specific task. This is called _____________. - ANS Joint ventures
The following is not a level of non-compliance: - ANS Mistake in billing
For potential criminal violations, a practice should have immediate discussions with a criminal
attorney who - ANS Is well versed in Healthcare Fraud and Abuse law
3
Page
@COPYRIGHT SIRJOEL 2025/2026
, The Compliance Officer's main two responsibilities are to ____________the
practice/organization's compliance program. - ANS develops and then implement
Judy is the Compliance Officer for Apple Medical Group. The providers of the group ask Judy to
design a new Compliance Plan. Should Judy ask some other practices in town for a copy of their
Compliance Plan? Do all Compliance Programs have to be the same regardless of the practice
size or specialty? Why? - ANS No, compliance programs need to be tailored to fit the unique
needs of every organization or physician practice
USSC is important as it related to the Federal Sentencing Guidelines and thus related to the
core elements of compliance. What does the USSC acronym stand for? - ANS United States
Sentencing Commission
Kathy, the Compliance Officer at a small provider office, is notified that a non-English speaking
patient will be arriving today. A LEP person/patient who needs an interpreter to translate to
and from the person's primary language must be provided. - ANS at no cost to the patient or
insurance carrier
In addition to hospitals, what other type of facility did the OIG provide supplemental
compliance program guidance for? - ANS Nursing Facilities
What is (are) considered a significant element(s) in fraud? - ANS Knowingly and Intent
Department of Labor requires compliance with employee and employer laws including: -
ANS FLSA, OSHA, CRA, ERISA
Which government branch was created to fight waste, fraud and abuse in all federal health care
programs especially Medicare, Medicaid? - ANS Office of Inspector General (OIG)
Dr. X is a very through provider. He always runs a full blood panel on each patient every year for
their physical. This is an example of: - ANS Waste
4
Page
@COPYRIGHT SIRJOEL 2025/2026
