HCCA CHC/CHPC COMPREHENSIVE
FINAL EXAM PREP QUESTIONS AND
ANSWERS LATEST UPDATE THIS YEAR
- JUST RELEASED
1. Under the Federal False Claims Act, what is the ‘scienter’ requirement for finding a
defendant liable?
A. Actual knowledge, deliberate ignorance, or reckless disregard.
B. Specific intent to defraud the government.
C. Negligence in the preparation of billing claims.
D. Direct evidence of a bribe or kickback.
Answer: A
Conceptual Explanation: The False Claims Act does not require specific intent to defraud;
rather, it defines ‘knowingly’ as actual knowledge, deliberate ignorance, or reckless
disregard of the truth or falsity of the information.
2. Which of the following is considered a ‘strict liability’ statute, meaning intent is irrelevant?
A. Anti-Kickback Statute
B. Health Care Fraud Statute
C. Civil Monetary Penalties Law
,D. Stark Law (Physician Self-Referral Law)
Answer: D
Conceptual Explanation: The Stark Law is a strict liability statute. If a financial
relationship exists and no exception is met, a violation has occurred regardless of the
parties’ intent.
3. According to the OIG, what is the recommended frequency for checking the List of Excluded
Individuals and Entities (LEIE)?
A. Annually
B. Upon hire only
C. Monthly
D. Every two years
Answer: C
Conceptual Explanation: The OIG recommends that providers check the LEIE on a
monthly basis to ensure that no employees or contractors have been excluded from federal
healthcare programs.
4. Under HIPAA, when a breach affects 500 or more individuals in a single jurisdiction, when
must the media be notified?
A. Only if the Secretary of HHS directs the entity to do so.
B. Immediately upon discovery.
, C. Within 30 days of the breach occurrence.
D. No later than 60 days following the discovery of the breach.
Answer: D
Conceptual Explanation: For breaches affecting 500 or more individuals, HIPAA requires
notice to prominent media outlets serving the State or jurisdiction no later than 60 days
after discovery.
5. What is the primary difference between ‘auditing’ and ‘monitoring’ in a compliance
program?
A. Auditing is done by the Compliance Officer, while monitoring is done by the Board.
B. Monitoring is only required for financial records, whereas auditing is for clinical records.
C. Auditing is a formal, independent review; monitoring is an ongoing, day-to-day process.
D. There is no practical difference; the terms are interchangeable in OIG guidance.
Answer: C
Conceptual Explanation: Monitoring is an ongoing, real-time process conducted by
management to ensure controls are working; auditing is a formal, retrospective review
often performed by someone independent of the process.
6. The ‘Whole Number’ or ‘60-Day Rule’ refers to what compliance obligation?
A. The time to return identified overpayments to CMS.
B. The time to report a HIPAA breach to the OCR.
FINAL EXAM PREP QUESTIONS AND
ANSWERS LATEST UPDATE THIS YEAR
- JUST RELEASED
1. Under the Federal False Claims Act, what is the ‘scienter’ requirement for finding a
defendant liable?
A. Actual knowledge, deliberate ignorance, or reckless disregard.
B. Specific intent to defraud the government.
C. Negligence in the preparation of billing claims.
D. Direct evidence of a bribe or kickback.
Answer: A
Conceptual Explanation: The False Claims Act does not require specific intent to defraud;
rather, it defines ‘knowingly’ as actual knowledge, deliberate ignorance, or reckless
disregard of the truth or falsity of the information.
2. Which of the following is considered a ‘strict liability’ statute, meaning intent is irrelevant?
A. Anti-Kickback Statute
B. Health Care Fraud Statute
C. Civil Monetary Penalties Law
,D. Stark Law (Physician Self-Referral Law)
Answer: D
Conceptual Explanation: The Stark Law is a strict liability statute. If a financial
relationship exists and no exception is met, a violation has occurred regardless of the
parties’ intent.
3. According to the OIG, what is the recommended frequency for checking the List of Excluded
Individuals and Entities (LEIE)?
A. Annually
B. Upon hire only
C. Monthly
D. Every two years
Answer: C
Conceptual Explanation: The OIG recommends that providers check the LEIE on a
monthly basis to ensure that no employees or contractors have been excluded from federal
healthcare programs.
4. Under HIPAA, when a breach affects 500 or more individuals in a single jurisdiction, when
must the media be notified?
A. Only if the Secretary of HHS directs the entity to do so.
B. Immediately upon discovery.
, C. Within 30 days of the breach occurrence.
D. No later than 60 days following the discovery of the breach.
Answer: D
Conceptual Explanation: For breaches affecting 500 or more individuals, HIPAA requires
notice to prominent media outlets serving the State or jurisdiction no later than 60 days
after discovery.
5. What is the primary difference between ‘auditing’ and ‘monitoring’ in a compliance
program?
A. Auditing is done by the Compliance Officer, while monitoring is done by the Board.
B. Monitoring is only required for financial records, whereas auditing is for clinical records.
C. Auditing is a formal, independent review; monitoring is an ongoing, day-to-day process.
D. There is no practical difference; the terms are interchangeable in OIG guidance.
Answer: C
Conceptual Explanation: Monitoring is an ongoing, real-time process conducted by
management to ensure controls are working; auditing is a formal, retrospective review
often performed by someone independent of the process.
6. The ‘Whole Number’ or ‘60-Day Rule’ refers to what compliance obligation?
A. The time to return identified overpayments to CMS.
B. The time to report a HIPAA breach to the OCR.
