CMS Compliance Certification Exam | Complete Practice
QUESTIONs, Verified Answers & Detailed Rationales
(2026/2027)
QUESTION 1
Which of the following is considered one of the seven core elements of
an effective healthcare compliance program as defined by the
Department of Health and Human Services Office of Inspector General
(HHS-OIG) and CMS guidelines?
• A. Guaranteeing a minimum annual profit margin for Medicare
Advantage plans.
• B. Establishing effective lines of communication, including an
anonymous reporting mechanism.
• C. Requiring all clinical staff to hold dual certifications in medical
coding.
• D. Conducting daily mandatory compliance audits for all clinical
encounters.
Correct Answer: B. Establishing effective lines of communication,
including an anonymous reporting mechanism.
Detailed Rationale: The OIG and CMS establish seven core elements for
an effective compliance program: implementing written policies and
procedures, designating a compliance officer and compliance
committee, conducting effective training and education, developing
effective lines of communication (such as a confidential hotline),
,conducting internal monitoring and auditing, enforcing standards
through well-publicized disciplinary guidelines, and responding
promptly to detected offenses and undertaking corrective action.
QUESTION 2
Under the False Claims Act (FCA), a healthcare provider or organization
can be held liable for submitting false or fraudulent claims to Medicare
or Medicaid. What is the statutory standard of intent required under
the FCA?
• A. Specific intent to defraud the federal government must be
proven beyond a reasonable doubt.
• B. Actual knowledge, deliberate ignorance, or reckless disregard of
the truth or falsity of the information.
• C. Simple negligence or accidental administrative clerical error.
• D. Proof of malice or personal ill will toward federal healthcare
programs.
Correct Answer: B. Actual knowledge, deliberate ignorance, or reckless
disregard of the truth or falsity of the information.
Detailed Rationale: The False Claims Act defines "knowingly" to include
actual knowledge, deliberate ignorance, or reckless disregard of the
truth or falsity of information. It explicitly does not require proof of
specific intent to defraud, meaning reckless billing practices can lead to
civil monetary penalties and treble damages.
QUESTION 3
A healthcare system wants to offer free transportation services to
Medicare beneficiaries living in rural areas to access scheduled primary
,care visits. Under the Anti-Kickback Statute (AKS) Beneficiary
Inducements Civil Monetary Penalty (CMP) exception, which condition
must be met?
• A. The transportation must be offered selectively to high-revenue
patients only.
• B. The service must be offered in air ambulances or luxury
vehicles.
• C. The transportation policy must be established in writing,
offered regardless of patient volume/value, and not be air, luxury,
or ambulance transport.
• D. Patients must be charged a mandatory sliding-scale fee for each
ride.
Correct Answer: C. The transportation policy must be established in
writing, offered regardless of patient volume/value, and not be air,
luxury, or ambulance transport.
Detailed Rationale: The OIG's safe harbor for local transportation under
the AKS and CMP law permits eligible entities to provide free or
discounted local transportation if established in a uniform written
policy, offered without regard to the volume or value of federal
healthcare program business, and provided via standard ground
transportation (not luxury or air) within specified distance limits (e.g.,
25 miles for urban areas, 50 miles for rural areas).
QUESTION 4
, Under CMS regulations, Medicare Advantage (MA) organizations and
Prescription Drug Plan (PDP) sponsors must retain all records related to
their contracts for a minimum period of:
• A. 3 years.
• B. 5 years.
• C. 7 years.
• D. 10 years.
Correct Answer: D. 10 years.
Detailed Rationale: CMS regulations (42 CFR § 422.504 and 42 CFR §
423.505) mandate that Medicare Advantage plans and Part D
prescription drug plan sponsors retain contract books, records,
documents, and operational data for a minimum of 10 years from the
final contract period end date, or completion of an audit, whichever is
later.
QUESTION 5
When an agent or broker conducts a sales presentation for Medicare
Advantage plans, CMS regulations strictly prohibit which of the
following activities during an educational event?
• A. Providing educational brochures about Medicare Parts A, B, C,
and D.
• B. Answering general QUESTIONs asked by attendees about
healthcare options.
• C. Distributing plan marketing materials, accepting plan
enrollment applications, or scheduling sales appointments.
QUESTIONs, Verified Answers & Detailed Rationales
(2026/2027)
QUESTION 1
Which of the following is considered one of the seven core elements of
an effective healthcare compliance program as defined by the
Department of Health and Human Services Office of Inspector General
(HHS-OIG) and CMS guidelines?
• A. Guaranteeing a minimum annual profit margin for Medicare
Advantage plans.
• B. Establishing effective lines of communication, including an
anonymous reporting mechanism.
• C. Requiring all clinical staff to hold dual certifications in medical
coding.
• D. Conducting daily mandatory compliance audits for all clinical
encounters.
Correct Answer: B. Establishing effective lines of communication,
including an anonymous reporting mechanism.
Detailed Rationale: The OIG and CMS establish seven core elements for
an effective compliance program: implementing written policies and
procedures, designating a compliance officer and compliance
committee, conducting effective training and education, developing
effective lines of communication (such as a confidential hotline),
,conducting internal monitoring and auditing, enforcing standards
through well-publicized disciplinary guidelines, and responding
promptly to detected offenses and undertaking corrective action.
QUESTION 2
Under the False Claims Act (FCA), a healthcare provider or organization
can be held liable for submitting false or fraudulent claims to Medicare
or Medicaid. What is the statutory standard of intent required under
the FCA?
• A. Specific intent to defraud the federal government must be
proven beyond a reasonable doubt.
• B. Actual knowledge, deliberate ignorance, or reckless disregard of
the truth or falsity of the information.
• C. Simple negligence or accidental administrative clerical error.
• D. Proof of malice or personal ill will toward federal healthcare
programs.
Correct Answer: B. Actual knowledge, deliberate ignorance, or reckless
disregard of the truth or falsity of the information.
Detailed Rationale: The False Claims Act defines "knowingly" to include
actual knowledge, deliberate ignorance, or reckless disregard of the
truth or falsity of information. It explicitly does not require proof of
specific intent to defraud, meaning reckless billing practices can lead to
civil monetary penalties and treble damages.
QUESTION 3
A healthcare system wants to offer free transportation services to
Medicare beneficiaries living in rural areas to access scheduled primary
,care visits. Under the Anti-Kickback Statute (AKS) Beneficiary
Inducements Civil Monetary Penalty (CMP) exception, which condition
must be met?
• A. The transportation must be offered selectively to high-revenue
patients only.
• B. The service must be offered in air ambulances or luxury
vehicles.
• C. The transportation policy must be established in writing,
offered regardless of patient volume/value, and not be air, luxury,
or ambulance transport.
• D. Patients must be charged a mandatory sliding-scale fee for each
ride.
Correct Answer: C. The transportation policy must be established in
writing, offered regardless of patient volume/value, and not be air,
luxury, or ambulance transport.
Detailed Rationale: The OIG's safe harbor for local transportation under
the AKS and CMP law permits eligible entities to provide free or
discounted local transportation if established in a uniform written
policy, offered without regard to the volume or value of federal
healthcare program business, and provided via standard ground
transportation (not luxury or air) within specified distance limits (e.g.,
25 miles for urban areas, 50 miles for rural areas).
QUESTION 4
, Under CMS regulations, Medicare Advantage (MA) organizations and
Prescription Drug Plan (PDP) sponsors must retain all records related to
their contracts for a minimum period of:
• A. 3 years.
• B. 5 years.
• C. 7 years.
• D. 10 years.
Correct Answer: D. 10 years.
Detailed Rationale: CMS regulations (42 CFR § 422.504 and 42 CFR §
423.505) mandate that Medicare Advantage plans and Part D
prescription drug plan sponsors retain contract books, records,
documents, and operational data for a minimum of 10 years from the
final contract period end date, or completion of an audit, whichever is
later.
QUESTION 5
When an agent or broker conducts a sales presentation for Medicare
Advantage plans, CMS regulations strictly prohibit which of the
following activities during an educational event?
• A. Providing educational brochures about Medicare Parts A, B, C,
and D.
• B. Answering general QUESTIONs asked by attendees about
healthcare options.
• C. Distributing plan marketing materials, accepting plan
enrollment applications, or scheduling sales appointments.
