CMS Regulatory Compliance Practice Exam | Most Tested
QUESTIONs, Correct Answers & Expert Rationale
2026/2027
QUESTION 1
Which of the following is the primary mission of the Centers for
Medicare & Medicaid Services (CMS)?
• A. To dictate the salary structures of all healthcare workers.
• B. To provide health coverage to more than 160 million people
through Medicare, Medicaid, CHIP, and the Marketplaces.
• C. To exclusively prosecute physicians for malpractice.
• D. To sell private health insurance plans directly to consumers.
Correct Answer: B. To provide health coverage to more than 160 million
people through Medicare, Medicaid, CHIP, and the Marketplaces.
Detailed Rationale: CMS is the federal agency within the U.S.
Department of Health and Human Services (HHS) that administers the
Medicare program and works in partnership with state governments to
administer Medicaid, CHIP, and health insurance portability standards.
QUESTION 2
Which of the following best differentiates "Fraud" from "Abuse"?
• A. Fraud involves intent to deceive for financial gain; abuse
involves practices that result in unnecessary costs but lack the
element of intent.
, • B. Fraud is billing for non-covered services; abuse is billing for
covered services.
• C. Fraud refers to minor clerical errors; abuse refers to systemic
illegal activity.
• D. They are synonymous terms and are used interchangeably in
federal regulations.
Correct Answer: A. Fraud involves intent to deceive for financial gain;
abuse involves practices that result in unnecessary costs but lack the
element of intent.
Detailed Rationale: Fraud requires a "knowing and willful" intent to
defraud the government. Abuse refers to inconsistent sound medical or
fiscal practices that result in improper payments, but without the clear
proof of intentional deception.
QUESTION 3
What is the core prohibition of the False Claims Act (FCA)?
• A. It prohibits physicians from treating patients outside of their
specialty.
• B. It prohibits the knowing submission of false or fraudulent
claims for payment to the government.
• C. It prohibits hospitals from keeping records longer than 7 years.
• D. It prohibits patients from changing their insurance providers
during the year.
Correct Answer: B. It prohibits the knowing submission of false or
fraudulent claims for payment to the government.
,Detailed Rationale: The FCA is a powerful tool used to combat fraud. It
imposes liability on anyone who knowingly submits (or causes to be
submitted) false claims to the government for payment.
QUESTION 4
The Stark Law (Physician Self-Referral Law) specifically prohibits:
• A. Any physician from owning stock in a pharmaceutical company.
• B. A physician from referring patients for "Designated Health
Services" to an entity with which they have a financial
relationship.
• C. A hospital from employing more than one physician in the same
department.
• D. A physician from referring a patient to another doctor in the
same city.
Correct Answer: B. A physician from referring patients for "Designated
Health Services" to an entity with which they have a financial
relationship.
Detailed Rationale: The Stark Law is a strict liability statute. It prohibits
self-referral for specific services (labs, imaging, etc.) if a financial
interest exists, unless a specific statutory or regulatory exception is met.
QUESTION 5
Which federal law prohibits the exchange of anything of value
(remuneration) to induce the referral of federal health care program
business?
• A. The Anti-Kickback Statute (AKS)
, • B. The Patient Protection and Affordable Care Act
• C. The Privacy Act of 1974
• D. The Emergency Medical Treatment and Labor Act (EMTALA)
Correct Answer: A. The Anti-Kickback Statute (AKS)
Detailed Rationale: The AKS is a criminal statute. It prohibits paying or
receiving "anything of value" in exchange for referrals. Unlike Stark, it
requires proof of intent to induce referrals.
QUESTION 6
Under EMTALA, what is a hospital's primary obligation when an
individual comes to the emergency department?
• A. To collect insurance information before providing any care.
• B. To provide an appropriate Medical Screening Examination
(MSE) to determine if an emergency medical condition exists.
• C. To treat only patients who can demonstrate they have the
ability to pay.
• D. To immediately transfer patients to private facilities to save
Medicare costs.
Correct Answer: B. To provide an appropriate Medical Screening
Examination (MSE) to determine if an emergency medical condition
exists.
Detailed Rationale: EMTALA (the "Patient Anti-Dumping Act") requires
that any hospital with an emergency department must screen and
stabilize anyone who comes to the ER, regardless of their ability to pay.
QUESTION 7
QUESTIONs, Correct Answers & Expert Rationale
2026/2027
QUESTION 1
Which of the following is the primary mission of the Centers for
Medicare & Medicaid Services (CMS)?
• A. To dictate the salary structures of all healthcare workers.
• B. To provide health coverage to more than 160 million people
through Medicare, Medicaid, CHIP, and the Marketplaces.
• C. To exclusively prosecute physicians for malpractice.
• D. To sell private health insurance plans directly to consumers.
Correct Answer: B. To provide health coverage to more than 160 million
people through Medicare, Medicaid, CHIP, and the Marketplaces.
Detailed Rationale: CMS is the federal agency within the U.S.
Department of Health and Human Services (HHS) that administers the
Medicare program and works in partnership with state governments to
administer Medicaid, CHIP, and health insurance portability standards.
QUESTION 2
Which of the following best differentiates "Fraud" from "Abuse"?
• A. Fraud involves intent to deceive for financial gain; abuse
involves practices that result in unnecessary costs but lack the
element of intent.
, • B. Fraud is billing for non-covered services; abuse is billing for
covered services.
• C. Fraud refers to minor clerical errors; abuse refers to systemic
illegal activity.
• D. They are synonymous terms and are used interchangeably in
federal regulations.
Correct Answer: A. Fraud involves intent to deceive for financial gain;
abuse involves practices that result in unnecessary costs but lack the
element of intent.
Detailed Rationale: Fraud requires a "knowing and willful" intent to
defraud the government. Abuse refers to inconsistent sound medical or
fiscal practices that result in improper payments, but without the clear
proof of intentional deception.
QUESTION 3
What is the core prohibition of the False Claims Act (FCA)?
• A. It prohibits physicians from treating patients outside of their
specialty.
• B. It prohibits the knowing submission of false or fraudulent
claims for payment to the government.
• C. It prohibits hospitals from keeping records longer than 7 years.
• D. It prohibits patients from changing their insurance providers
during the year.
Correct Answer: B. It prohibits the knowing submission of false or
fraudulent claims for payment to the government.
,Detailed Rationale: The FCA is a powerful tool used to combat fraud. It
imposes liability on anyone who knowingly submits (or causes to be
submitted) false claims to the government for payment.
QUESTION 4
The Stark Law (Physician Self-Referral Law) specifically prohibits:
• A. Any physician from owning stock in a pharmaceutical company.
• B. A physician from referring patients for "Designated Health
Services" to an entity with which they have a financial
relationship.
• C. A hospital from employing more than one physician in the same
department.
• D. A physician from referring a patient to another doctor in the
same city.
Correct Answer: B. A physician from referring patients for "Designated
Health Services" to an entity with which they have a financial
relationship.
Detailed Rationale: The Stark Law is a strict liability statute. It prohibits
self-referral for specific services (labs, imaging, etc.) if a financial
interest exists, unless a specific statutory or regulatory exception is met.
QUESTION 5
Which federal law prohibits the exchange of anything of value
(remuneration) to induce the referral of federal health care program
business?
• A. The Anti-Kickback Statute (AKS)
, • B. The Patient Protection and Affordable Care Act
• C. The Privacy Act of 1974
• D. The Emergency Medical Treatment and Labor Act (EMTALA)
Correct Answer: A. The Anti-Kickback Statute (AKS)
Detailed Rationale: The AKS is a criminal statute. It prohibits paying or
receiving "anything of value" in exchange for referrals. Unlike Stark, it
requires proof of intent to induce referrals.
QUESTION 6
Under EMTALA, what is a hospital's primary obligation when an
individual comes to the emergency department?
• A. To collect insurance information before providing any care.
• B. To provide an appropriate Medical Screening Examination
(MSE) to determine if an emergency medical condition exists.
• C. To treat only patients who can demonstrate they have the
ability to pay.
• D. To immediately transfer patients to private facilities to save
Medicare costs.
Correct Answer: B. To provide an appropriate Medical Screening
Examination (MSE) to determine if an emergency medical condition
exists.
Detailed Rationale: EMTALA (the "Patient Anti-Dumping Act") requires
that any hospital with an emergency department must screen and
stabilize anyone who comes to the ER, regardless of their ability to pay.
QUESTION 7
