CHC UPDATED TEST PRACTICE EXAM QUESTIONS AND
SOLUTIONS RATED A+
✔✔HCCA - 2 basic components of a compliance program - ✔✔1. Structural
2. Substantive
✔✔HCCA-"Structural Component" - ✔✔OIG 7 elements
✔✔HCCA-"Substantive Component" - ✔✔Specific bodies of law such as Medicare,
Medicaid, AKS,Stark,ERISA.
✔✔FSG-COMPLIANCE Program def - ✔✔A program that has been reasonably
desigbed, implemented, and enforces so that it generally will be effective in preventing
and detecting criminal conduct.
✔✔FSG-7 elements - ✔✔1 . Compliance standards (P&P ect)
2. High Level Responsibility
3. Trustworthy indv
4 . Education
5 Monitoring
6. Enforcement
7.Response and Prevention
✔✔HCCA- Evaluation and Measurement 2 dimensions - ✔✔1 . EFFORT
2. OUTCOMES
✔✔HCCA- effort - ✔✔Time money resources commitment
✔✔HCCA-outcomes - ✔✔Impact efforts have had on level of compliance
✔✔FCA - LIABILITY - ✔✔Knowingly submits,causes another to submit a false claim,or
knowingly makes a false record or statement to get a false claim paid by government.
Conspire to to violate FCA. Also see reverse FC section
✔✔FCA - LIABILITY cont "Reverse false claim section " - ✔✔Act improperly to avoid
having to pay government.
✔✔FCA - DAMAGES and PENALTIES - ✔✔Fines of $5k- 10k (varies due to
adjustments ) /claim plus treble government damages unless self-reported then under
certain circumstances not less than double government damages
✔✔FCA-Knowledge requirement - ✔✔3729(b)(1)
1. Actually knowledge
2 . Deliberate ignorance of truth or falsity of information
, 3.Reckless disregard for of the truth or falsity of the information
✔✔FCA-"claim" - ✔✔Demand for money or property made to Federal Government or
contractor,grantee,or other recipient if the money is spent on the government's behalf
and if Federal Government provides any of the money demanded or if the Federal
Government will reimburse the contractor or grantee. *Doesn't apply to tax claims*
✔✔FCA - qui tam provision - ✔✔Allows private persons to file suit for violations of FCA
on behalf of the government.
✔✔FCA-"relator" - ✔✔Person bringing qui Tam suit
✔✔FCA - qui tam process - ✔✔Made under seal to US Attorney of the judicial district
where filed and on the AG of US. Stays sealed for 60 days while feds investigate.
Government then notifies relator that they will proceed "intervening" or decline. If
declined relator can proceed. Relator must get fed approval for settlement. If
government intervenes 15 - 25% to relator. If declined 25-30% for relator.
✔✔HCCA - "code of conduct" - ✔✔Sets forth in general terms the organization's
commitment to comply with the law.
✔✔HCCA - 3 broad categories of policies and procedures - ✔✔i. CODE OF CONDUCT
ii. OPERATION OF COMPLIANCE PROGRAM
iii. Addressing organization's principal
✔✔HCCA -P&P - ✔✔P&P Outcome :
*audits reveal fewer errors
*Successful testing of internal controls
*Employees can express understanding of P&P
✔✔HCCA -Ongoing Education and Training - ✔✔Goals:
*Promote understanding of compliance program,
*Employees understand their role in compliance process
*Demonstrate organizational comitment to compliance efforts
*Communicate industry standards
✔✔HCCA -Education :
"Structural vs substantive - ✔✔1. Structural, how compliance program operates
2. Substantive, specific laws and regulations that directly impact organization
✔✔"ERISA" - ✔✔Employment Retirement Income Security Act of 1974
✔✔ERISA-amendnents - ✔✔COBRA ,HIPAA,Mental Health Parity Act,Newborn and
Mother's Health Protection Act,Womens Health and Cancer Right Act
SOLUTIONS RATED A+
✔✔HCCA - 2 basic components of a compliance program - ✔✔1. Structural
2. Substantive
✔✔HCCA-"Structural Component" - ✔✔OIG 7 elements
✔✔HCCA-"Substantive Component" - ✔✔Specific bodies of law such as Medicare,
Medicaid, AKS,Stark,ERISA.
✔✔FSG-COMPLIANCE Program def - ✔✔A program that has been reasonably
desigbed, implemented, and enforces so that it generally will be effective in preventing
and detecting criminal conduct.
✔✔FSG-7 elements - ✔✔1 . Compliance standards (P&P ect)
2. High Level Responsibility
3. Trustworthy indv
4 . Education
5 Monitoring
6. Enforcement
7.Response and Prevention
✔✔HCCA- Evaluation and Measurement 2 dimensions - ✔✔1 . EFFORT
2. OUTCOMES
✔✔HCCA- effort - ✔✔Time money resources commitment
✔✔HCCA-outcomes - ✔✔Impact efforts have had on level of compliance
✔✔FCA - LIABILITY - ✔✔Knowingly submits,causes another to submit a false claim,or
knowingly makes a false record or statement to get a false claim paid by government.
Conspire to to violate FCA. Also see reverse FC section
✔✔FCA - LIABILITY cont "Reverse false claim section " - ✔✔Act improperly to avoid
having to pay government.
✔✔FCA - DAMAGES and PENALTIES - ✔✔Fines of $5k- 10k (varies due to
adjustments ) /claim plus treble government damages unless self-reported then under
certain circumstances not less than double government damages
✔✔FCA-Knowledge requirement - ✔✔3729(b)(1)
1. Actually knowledge
2 . Deliberate ignorance of truth or falsity of information
, 3.Reckless disregard for of the truth or falsity of the information
✔✔FCA-"claim" - ✔✔Demand for money or property made to Federal Government or
contractor,grantee,or other recipient if the money is spent on the government's behalf
and if Federal Government provides any of the money demanded or if the Federal
Government will reimburse the contractor or grantee. *Doesn't apply to tax claims*
✔✔FCA - qui tam provision - ✔✔Allows private persons to file suit for violations of FCA
on behalf of the government.
✔✔FCA-"relator" - ✔✔Person bringing qui Tam suit
✔✔FCA - qui tam process - ✔✔Made under seal to US Attorney of the judicial district
where filed and on the AG of US. Stays sealed for 60 days while feds investigate.
Government then notifies relator that they will proceed "intervening" or decline. If
declined relator can proceed. Relator must get fed approval for settlement. If
government intervenes 15 - 25% to relator. If declined 25-30% for relator.
✔✔HCCA - "code of conduct" - ✔✔Sets forth in general terms the organization's
commitment to comply with the law.
✔✔HCCA - 3 broad categories of policies and procedures - ✔✔i. CODE OF CONDUCT
ii. OPERATION OF COMPLIANCE PROGRAM
iii. Addressing organization's principal
✔✔HCCA -P&P - ✔✔P&P Outcome :
*audits reveal fewer errors
*Successful testing of internal controls
*Employees can express understanding of P&P
✔✔HCCA -Ongoing Education and Training - ✔✔Goals:
*Promote understanding of compliance program,
*Employees understand their role in compliance process
*Demonstrate organizational comitment to compliance efforts
*Communicate industry standards
✔✔HCCA -Education :
"Structural vs substantive - ✔✔1. Structural, how compliance program operates
2. Substantive, specific laws and regulations that directly impact organization
✔✔"ERISA" - ✔✔Employment Retirement Income Security Act of 1974
✔✔ERISA-amendnents - ✔✔COBRA ,HIPAA,Mental Health Parity Act,Newborn and
Mother's Health Protection Act,Womens Health and Cancer Right Act
