HCCA- CHC ACTUAL EXAM 150 QUESTIONS AND CORRECT ANSWERS
WITH RATIONALES 2026 LATEST VERSION COVERING THE RECENT
TESTED QUESTIONS PERFECT FOR HIGHER PASS GRADES
1. Which federal law governs the privacy and security of patient health information?
A. HIPAA
B. HITECH
C. ACA
D. Stark Law
Rationale: HIPAA (Health Insurance Portability and Accountability Act) sets standards for the protection
of PHI (Protected Health Information).
2. The main purpose of the False Claims Act (FCA) is:
A. Prevent fraud and abuse in federal healthcare programs
B. Ensure hospital accreditation
C. Mandate electronic health records
D. Regulate hospital staffing
Rationale: The FCA allows the government to pursue individuals or entities that submit false claims to
federal programs like Medicare and Medicaid.
3. Which organization enforces the Anti-Kickback Statute?
A. HHS-OIG
B. CMS
C. FDA
D. Joint Commission
Rationale: The Office of Inspector General (OIG) enforces laws prohibiting improper remuneration in
federal healthcare programs.
4. Which element is NOT required in an effective compliance program according to the OIG?
A. Written policies and procedures
B. Compliance training
C. Independent auditing
D. Patient billing approval by CEO
Rationale: While policies, training, and auditing are required, the CEO’s personal approval of billing is
not mandated.
,5. A compliance officer discovers a billing error. What is the first step?
A. Correct the error and self-report if required
B. Ignore it
C. Notify the press
D. Fire the staff
Rationale: Correcting errors promptly and self-reporting potential violations aligns with compliance
program best practices.
6. Which law limits physician self-referral for Medicare and Medicaid patients?
A. Stark Law
B. Anti-Kickback Statute
C. HIPAA
D. False Claims Act
Rationale: The Stark Law prohibits physician referrals for certain designated health services payable by
Medicare/Medicaid to entities in which the physician has a financial interest.
7. What is the primary purpose of the Office of Inspector General (OIG) Work Plan?
A. Outline areas of compliance risk to focus audits
B. Issue hospital licenses
C. Approve EHR systems
D. Certify nursing programs
Rationale: The OIG Work Plan identifies areas at high risk for fraud, waste, and abuse.
8. Which of the following is an example of a compliance risk?
A. Failure to document medical necessity
B. Maintaining EHR access logs
C. Annual staff training
D. Following HIPAA policies
Rationale: Failing to properly document medical necessity increases risk of overpayments or FCA
violations.
9. Which federal agency oversees enforcement of HIPAA?
A. OCR (Office for Civil Rights)
B. FDA
C. CMS
D. DEA
Rationale: The OCR within HHS enforces HIPAA privacy and security rules.
,10. What is a “business associate” under HIPAA?
A. An entity performing services on behalf of a covered entity that involves PHI
B. Any patient
C. Hospital CEO
D. Government auditor
Rationale: Business associates handle PHI for covered entities and must sign BAAs (Business Associate
Agreements).
11. Which is a “safe harbor” under the Anti-Kickback Statute?
A. Certain arrangements that pose low risk of fraud
B. Any payment to a physician
C. All consulting arrangements
D. Any charitable contribution
Rationale: Safe harbors protect specific payment practices that are considered low risk for abuse or
fraud.
12. Which compliance activity involves proactively identifying and addressing risks?
A. Auditing
B. Reporting
C. Billing
D. Hiring staff
Rationale: Auditing and monitoring are proactive compliance activities to detect and mitigate risks.
13. Which of the following is an example of a potential FCA violation?
A. Billing for services not provided
B. Staff meetings
C. Updating policies
D. Employee training
Rationale: Submitting claims for services not rendered is considered fraudulent under the False Claims
Act.
14. Which agency administers Medicare and Medicaid?
A. CMS
B. FDA
C. OIG
, D. DEA
Rationale: Centers for Medicare & Medicaid Services (CMS) manages these programs.
15. What is the role of a compliance officer?
A. Oversee adherence to regulatory requirements
B. Perform surgeries
C. Approve hospital construction
D. Audit financial statements only
Rationale: Compliance officers ensure policies, training, and auditing prevent regulatory violations.
16. Which document outlines a healthcare organization’s ethical and legal obligations?
A. Code of Conduct
B. Mission statement
C. Strategic plan
D. Employee handbook
Rationale: A Code of Conduct communicates legal and ethical expectations to all employees.
17. The Stark Law applies to:
A. Physician self-referrals for designated health services
B. Nurse staffing
C. Hospital cafeteria
D. Health IT purchases
Rationale: Stark Law specifically prohibits certain physician self-referrals.
18. Which type of risk assessment evaluates potential legal, regulatory, and financial risks?
A. Compliance risk assessment
B. Clinical audit
C. Safety drill
D. Marketing survey
Rationale: Compliance risk assessments identify areas where the organization is vulnerable to violations.
19. Which law requires healthcare organizations to disclose overpayments within 60 days?
A. ACA
B. HIPAA
C. Stark Law
WITH RATIONALES 2026 LATEST VERSION COVERING THE RECENT
TESTED QUESTIONS PERFECT FOR HIGHER PASS GRADES
1. Which federal law governs the privacy and security of patient health information?
A. HIPAA
B. HITECH
C. ACA
D. Stark Law
Rationale: HIPAA (Health Insurance Portability and Accountability Act) sets standards for the protection
of PHI (Protected Health Information).
2. The main purpose of the False Claims Act (FCA) is:
A. Prevent fraud and abuse in federal healthcare programs
B. Ensure hospital accreditation
C. Mandate electronic health records
D. Regulate hospital staffing
Rationale: The FCA allows the government to pursue individuals or entities that submit false claims to
federal programs like Medicare and Medicaid.
3. Which organization enforces the Anti-Kickback Statute?
A. HHS-OIG
B. CMS
C. FDA
D. Joint Commission
Rationale: The Office of Inspector General (OIG) enforces laws prohibiting improper remuneration in
federal healthcare programs.
4. Which element is NOT required in an effective compliance program according to the OIG?
A. Written policies and procedures
B. Compliance training
C. Independent auditing
D. Patient billing approval by CEO
Rationale: While policies, training, and auditing are required, the CEO’s personal approval of billing is
not mandated.
,5. A compliance officer discovers a billing error. What is the first step?
A. Correct the error and self-report if required
B. Ignore it
C. Notify the press
D. Fire the staff
Rationale: Correcting errors promptly and self-reporting potential violations aligns with compliance
program best practices.
6. Which law limits physician self-referral for Medicare and Medicaid patients?
A. Stark Law
B. Anti-Kickback Statute
C. HIPAA
D. False Claims Act
Rationale: The Stark Law prohibits physician referrals for certain designated health services payable by
Medicare/Medicaid to entities in which the physician has a financial interest.
7. What is the primary purpose of the Office of Inspector General (OIG) Work Plan?
A. Outline areas of compliance risk to focus audits
B. Issue hospital licenses
C. Approve EHR systems
D. Certify nursing programs
Rationale: The OIG Work Plan identifies areas at high risk for fraud, waste, and abuse.
8. Which of the following is an example of a compliance risk?
A. Failure to document medical necessity
B. Maintaining EHR access logs
C. Annual staff training
D. Following HIPAA policies
Rationale: Failing to properly document medical necessity increases risk of overpayments or FCA
violations.
9. Which federal agency oversees enforcement of HIPAA?
A. OCR (Office for Civil Rights)
B. FDA
C. CMS
D. DEA
Rationale: The OCR within HHS enforces HIPAA privacy and security rules.
,10. What is a “business associate” under HIPAA?
A. An entity performing services on behalf of a covered entity that involves PHI
B. Any patient
C. Hospital CEO
D. Government auditor
Rationale: Business associates handle PHI for covered entities and must sign BAAs (Business Associate
Agreements).
11. Which is a “safe harbor” under the Anti-Kickback Statute?
A. Certain arrangements that pose low risk of fraud
B. Any payment to a physician
C. All consulting arrangements
D. Any charitable contribution
Rationale: Safe harbors protect specific payment practices that are considered low risk for abuse or
fraud.
12. Which compliance activity involves proactively identifying and addressing risks?
A. Auditing
B. Reporting
C. Billing
D. Hiring staff
Rationale: Auditing and monitoring are proactive compliance activities to detect and mitigate risks.
13. Which of the following is an example of a potential FCA violation?
A. Billing for services not provided
B. Staff meetings
C. Updating policies
D. Employee training
Rationale: Submitting claims for services not rendered is considered fraudulent under the False Claims
Act.
14. Which agency administers Medicare and Medicaid?
A. CMS
B. FDA
C. OIG
, D. DEA
Rationale: Centers for Medicare & Medicaid Services (CMS) manages these programs.
15. What is the role of a compliance officer?
A. Oversee adherence to regulatory requirements
B. Perform surgeries
C. Approve hospital construction
D. Audit financial statements only
Rationale: Compliance officers ensure policies, training, and auditing prevent regulatory violations.
16. Which document outlines a healthcare organization’s ethical and legal obligations?
A. Code of Conduct
B. Mission statement
C. Strategic plan
D. Employee handbook
Rationale: A Code of Conduct communicates legal and ethical expectations to all employees.
17. The Stark Law applies to:
A. Physician self-referrals for designated health services
B. Nurse staffing
C. Hospital cafeteria
D. Health IT purchases
Rationale: Stark Law specifically prohibits certain physician self-referrals.
18. Which type of risk assessment evaluates potential legal, regulatory, and financial risks?
A. Compliance risk assessment
B. Clinical audit
C. Safety drill
D. Marketing survey
Rationale: Compliance risk assessments identify areas where the organization is vulnerable to violations.
19. Which law requires healthcare organizations to disclose overpayments within 60 days?
A. ACA
B. HIPAA
C. Stark Law
