Compliance 101 Exam Questions and
Answers 100% Solved | Graded A+
compliance program - ✔✔prevention, detection, collaboration, and
enforcement
Effective compliance program - ✔✔must be an ongoing process and
commitment to an ethical way of conducting business
Office of Inspector General and Justice Department - ✔✔is responsible for
enforcing the rules and regulations under the Medicare and Medicaid laws
outline as part of the SSA by CMS.
Benefits of compliance program addressed by OIG - ✔✔safeguards the
organizations' legal responsibility to abide by applicable laws and
regulations.
Corporate Integrity Agreement (CIA) - ✔✔government imposed compliance
program
Why compliance programs are essential - ✔✔prevent paybacks, probation,
government designed programs, exclusion, reduce threat of lawsuits from
whistleblowers (qui tam).
1
©NINJANERD 2025/2026. YEAR PUBLISHED 2025.
,OIG Top 10 reasons to implement a compliance program -
✔✔demonstrates a strong commitment to honesty and responsible
corporate relations, reinforces employees sense of right and wrong, fulfill
legal duty to payers, cost effective, more accurate view of what is going on,
quality of care to clients, provides procedures to promptly correct
misconduct, mitigate any sanction imposed by government.
Health Insurance Portability and Accountability Act of 1996 (HIPAA) - ✔✔a
criminal offense to submit claims based on incorrect codes or medically
unnecessary services, and government has the power to exclude an
organization from Medicare/caid and other govt programs.
Balanced Budget Act of 1997 - ✔✔three strikes and your out clause ,
requiring permanent expulsion if found guilty of fraud a third time.
False Claims Act (FCA) - ✔✔empowers the govt to investigate and bring
civil action in fraud cases. Implemented in Civil War to control price
gouging.
Qui tam - ✔✔is a whistleblower who brings the fraud to light.
A whistleblower can receive a % of the govt's total award - ✔✔15-25% if
DOJ assumes the case or 25-30% if DOJ declines
2
©NINJANERD 2025/2026. YEAR PUBLISHED 2025.
, To avoid lengthy and expensive litigation, an organization can negotiate a
____________with the govt admits no fault or liability but does submit to a
govt plan for corrective action. - ✔✔CIA
Length of CIAs - ✔✔3-5 yrs with some lasting up to 8 yrs
1984 Congress enacted Sentencing reform act which includes FSG -
✔✔act designed to correct inequities in federal sentencing and give
guidance for assessing fines and methods for calculation of culpability
score.
The culpability score - ✔✔calculation of the degree of blame or guilt used
to determine fines, restitution, forfeiture, and probation.
If an upper level employee has participated in or was willfully ignorant of an
offense, - ✔✔the likelihood of culpability score will be increased.
If an organization reports a violation promptly, - ✔✔the culpability score
may be mitigated.
An aggravating factor in FSG - ✔✔is that the organization has had a
repeated offense
A mitigating factor for FSG - ✔✔is that the organization cooperated with the
govt investigators
3
©NINJANERD 2025/2026. YEAR PUBLISHED 2025.
Answers 100% Solved | Graded A+
compliance program - ✔✔prevention, detection, collaboration, and
enforcement
Effective compliance program - ✔✔must be an ongoing process and
commitment to an ethical way of conducting business
Office of Inspector General and Justice Department - ✔✔is responsible for
enforcing the rules and regulations under the Medicare and Medicaid laws
outline as part of the SSA by CMS.
Benefits of compliance program addressed by OIG - ✔✔safeguards the
organizations' legal responsibility to abide by applicable laws and
regulations.
Corporate Integrity Agreement (CIA) - ✔✔government imposed compliance
program
Why compliance programs are essential - ✔✔prevent paybacks, probation,
government designed programs, exclusion, reduce threat of lawsuits from
whistleblowers (qui tam).
1
©NINJANERD 2025/2026. YEAR PUBLISHED 2025.
,OIG Top 10 reasons to implement a compliance program -
✔✔demonstrates a strong commitment to honesty and responsible
corporate relations, reinforces employees sense of right and wrong, fulfill
legal duty to payers, cost effective, more accurate view of what is going on,
quality of care to clients, provides procedures to promptly correct
misconduct, mitigate any sanction imposed by government.
Health Insurance Portability and Accountability Act of 1996 (HIPAA) - ✔✔a
criminal offense to submit claims based on incorrect codes or medically
unnecessary services, and government has the power to exclude an
organization from Medicare/caid and other govt programs.
Balanced Budget Act of 1997 - ✔✔three strikes and your out clause ,
requiring permanent expulsion if found guilty of fraud a third time.
False Claims Act (FCA) - ✔✔empowers the govt to investigate and bring
civil action in fraud cases. Implemented in Civil War to control price
gouging.
Qui tam - ✔✔is a whistleblower who brings the fraud to light.
A whistleblower can receive a % of the govt's total award - ✔✔15-25% if
DOJ assumes the case or 25-30% if DOJ declines
2
©NINJANERD 2025/2026. YEAR PUBLISHED 2025.
, To avoid lengthy and expensive litigation, an organization can negotiate a
____________with the govt admits no fault or liability but does submit to a
govt plan for corrective action. - ✔✔CIA
Length of CIAs - ✔✔3-5 yrs with some lasting up to 8 yrs
1984 Congress enacted Sentencing reform act which includes FSG -
✔✔act designed to correct inequities in federal sentencing and give
guidance for assessing fines and methods for calculation of culpability
score.
The culpability score - ✔✔calculation of the degree of blame or guilt used
to determine fines, restitution, forfeiture, and probation.
If an upper level employee has participated in or was willfully ignorant of an
offense, - ✔✔the likelihood of culpability score will be increased.
If an organization reports a violation promptly, - ✔✔the culpability score
may be mitigated.
An aggravating factor in FSG - ✔✔is that the organization has had a
repeated offense
A mitigating factor for FSG - ✔✔is that the organization cooperated with the
govt investigators
3
©NINJANERD 2025/2026. YEAR PUBLISHED 2025.
