HCCA- CHC EXAM, PRACTICE EXAM AND STUDY GUIDE NEWEST 2026
ACTUAL EXAM 150+ QUESTIONS AND CORRECT DETAILED
ANSWERS WITH RATIONALES PERFECT FOR A+ GRADE
1. What is the primary purpose of the Federal False Claims Act (FCA)?
A. Regulate healthcare facility licensing
B. Prevent fraud against federal healthcare programs
C. Provide malpractice protection
D. Establish HIPAA rules
Rationale: The FCA targets fraud and abuse in federal healthcare programs like Medicare and
Medicaid.
2. Which government agency enforces the Anti-Kickback Statute (AKS)?
A. CMS
B. DOJ and HHS OIG
C. FDA
D. CDC
Rationale: DOJ and OIG investigate and prosecute violations of AKS.
3. What is a key element of a compliance program under the OIG guidance?
A. Marketing plans
B. Written policies, training, and monitoring
C. Patient satisfaction surveys
D. Billing audits only
Rationale: Effective compliance programs include policies, education, auditing, and
enforcement.
4. Which law protects whistleblowers reporting healthcare fraud?
A. HIPAA
B. Stark Law
C. False Claims Act
D. ACA
,Rationale: The FCA includes qui tam provisions allowing employees to report fraud and receive
rewards.
5. What does Stark Law prohibit?
A. Billing for unprovided services
B. Physician self-referral to entities where they have a financial interest
C. Kickbacks to employees
D. Improper coding
Rationale: Stark Law prevents conflicts of interest in physician referrals.
6. Which action is considered a violation of HIPAA Privacy Rule?
A. Sharing patient info with authorized staff
B. Disclosing PHI without patient consent
C. Using PHI for treatment
D. Discussing info with patient
Rationale: HIPAA protects patient health information from unauthorized disclosure.
7. What is the Safe Harbor provision under AKS?
A. Exceptions where certain arrangements do not violate the law
B. A state-specific exemption
C. Allows all referrals
D. Permits fraud reporting
Rationale: Safe Harbor rules clarify permissible business arrangements under AKS.
8. What is the main focus of OIG Work Plan?
A. Marketing strategies
B. Identifying areas at risk for fraud, waste, and abuse
C. Licensing
D. Clinical outcomes
Rationale: The OIG Work Plan guides audits and investigations to detect noncompliance.
,9. Which is an example of a compliance risk area?
A. Employee scheduling
B. Billing and coding practices
C. Parking enforcement
D. Clinical workflow
Rationale: Billing and coding are high-risk areas for regulatory violations.
10. What is a key responsibility of a compliance officer?
A. Manage IT systems
B. Oversee compliance program and report violations
C. Treat patients
D. Prepare marketing materials
Rationale: Compliance officers implement and monitor programs to ensure regulatory
adherence.
11. What is due diligence in healthcare compliance?
A. Hiring staff without background checks
B. Investigating third-party vendors and contracts
C. Ignoring contracts
D. Annual marketing plans
Rationale: Due diligence assesses risk before engaging vendors or partners.
12. Which is a potential consequence of noncompliance with federal healthcare laws?
A. Recognition awards
B. Civil monetary penalties and fines
C. Marketing benefits
D. No consequences
Rationale: Noncompliance can result in fines, exclusion, or imprisonment.
13. What is the purpose of auditing and monitoring in a compliance program?
, A. Promote marketing
B. Detect and prevent violations
C. Increase patient load
D. Reduce staffing needs
Rationale: Audits identify issues proactively before they become violations.
14. Which of the following is a red flag for fraud?
A. Legitimate claims submitted
B. Billing for services not provided
C. Accurate coding
D. Proper documentation
Rationale: Billing for unprovided services is a common indicator of fraud.
15. What is a compliance hotline used for?
A. Patient scheduling
B. Reporting suspected violations anonymously
C. Marketing calls
D. Payroll
Rationale: Hotlines allow employees to report concerns safely and confidentially.
16. Which agency enforces Stark Law?
A. DEA
B. CMS
C. FDA
D. OSHA
Rationale: CMS oversees physician self-referral regulations and can impose sanctions.
17. What is kickback in healthcare?
A. Legal payment for services
B. Payment for referrals or inducing business
C. Patient reimbursement
D. Tax deduction
ACTUAL EXAM 150+ QUESTIONS AND CORRECT DETAILED
ANSWERS WITH RATIONALES PERFECT FOR A+ GRADE
1. What is the primary purpose of the Federal False Claims Act (FCA)?
A. Regulate healthcare facility licensing
B. Prevent fraud against federal healthcare programs
C. Provide malpractice protection
D. Establish HIPAA rules
Rationale: The FCA targets fraud and abuse in federal healthcare programs like Medicare and
Medicaid.
2. Which government agency enforces the Anti-Kickback Statute (AKS)?
A. CMS
B. DOJ and HHS OIG
C. FDA
D. CDC
Rationale: DOJ and OIG investigate and prosecute violations of AKS.
3. What is a key element of a compliance program under the OIG guidance?
A. Marketing plans
B. Written policies, training, and monitoring
C. Patient satisfaction surveys
D. Billing audits only
Rationale: Effective compliance programs include policies, education, auditing, and
enforcement.
4. Which law protects whistleblowers reporting healthcare fraud?
A. HIPAA
B. Stark Law
C. False Claims Act
D. ACA
,Rationale: The FCA includes qui tam provisions allowing employees to report fraud and receive
rewards.
5. What does Stark Law prohibit?
A. Billing for unprovided services
B. Physician self-referral to entities where they have a financial interest
C. Kickbacks to employees
D. Improper coding
Rationale: Stark Law prevents conflicts of interest in physician referrals.
6. Which action is considered a violation of HIPAA Privacy Rule?
A. Sharing patient info with authorized staff
B. Disclosing PHI without patient consent
C. Using PHI for treatment
D. Discussing info with patient
Rationale: HIPAA protects patient health information from unauthorized disclosure.
7. What is the Safe Harbor provision under AKS?
A. Exceptions where certain arrangements do not violate the law
B. A state-specific exemption
C. Allows all referrals
D. Permits fraud reporting
Rationale: Safe Harbor rules clarify permissible business arrangements under AKS.
8. What is the main focus of OIG Work Plan?
A. Marketing strategies
B. Identifying areas at risk for fraud, waste, and abuse
C. Licensing
D. Clinical outcomes
Rationale: The OIG Work Plan guides audits and investigations to detect noncompliance.
,9. Which is an example of a compliance risk area?
A. Employee scheduling
B. Billing and coding practices
C. Parking enforcement
D. Clinical workflow
Rationale: Billing and coding are high-risk areas for regulatory violations.
10. What is a key responsibility of a compliance officer?
A. Manage IT systems
B. Oversee compliance program and report violations
C. Treat patients
D. Prepare marketing materials
Rationale: Compliance officers implement and monitor programs to ensure regulatory
adherence.
11. What is due diligence in healthcare compliance?
A. Hiring staff without background checks
B. Investigating third-party vendors and contracts
C. Ignoring contracts
D. Annual marketing plans
Rationale: Due diligence assesses risk before engaging vendors or partners.
12. Which is a potential consequence of noncompliance with federal healthcare laws?
A. Recognition awards
B. Civil monetary penalties and fines
C. Marketing benefits
D. No consequences
Rationale: Noncompliance can result in fines, exclusion, or imprisonment.
13. What is the purpose of auditing and monitoring in a compliance program?
, A. Promote marketing
B. Detect and prevent violations
C. Increase patient load
D. Reduce staffing needs
Rationale: Audits identify issues proactively before they become violations.
14. Which of the following is a red flag for fraud?
A. Legitimate claims submitted
B. Billing for services not provided
C. Accurate coding
D. Proper documentation
Rationale: Billing for unprovided services is a common indicator of fraud.
15. What is a compliance hotline used for?
A. Patient scheduling
B. Reporting suspected violations anonymously
C. Marketing calls
D. Payroll
Rationale: Hotlines allow employees to report concerns safely and confidentially.
16. Which agency enforces Stark Law?
A. DEA
B. CMS
C. FDA
D. OSHA
Rationale: CMS oversees physician self-referral regulations and can impose sanctions.
17. What is kickback in healthcare?
A. Legal payment for services
B. Payment for referrals or inducing business
C. Patient reimbursement
D. Tax deduction
