CHC LATEST 2026 PRACTICE EXAM QUESTIONS AND
SOLUTIONS RATED A+
✔✔FSG-Pervasiveness under subsection b. - ✔✔Case specific, depends on number
and degree of responsibility, of individuals within substantial authority personnel who
participated in,condoned, or were willfully ignorant of the offense.
✔✔Obstruction does not apply to - ✔✔Individuals hiding from organization
✔✔5 most important federal fraud and abuse laws - ✔✔*False Claims Act (FCA)
*Ant - kickback Statute (AKS)
*Physician Self-referral *Law (Stark I II III )
*Exclusion Authorities
*Civil Monetary Penalties Law (CMPL)
✔✔Stark - designated health services (DHS) - ✔✔*labs
*PT,OT,Outpatient Speech/Language Pathology
*Radiology, some other imaging
*Radiation therapy, supplies
*DME
*Parenteral enteral nutrients supplies
*Prosthetic Orthotic supplies devices
*Home Health services
*Outpatient Rx drugs
*Inpatient and Outpatient Hospital Services
✔✔Stark - strict liability - ✔✔Proof of intent not required to prosecute
✔✔Stark - ✔✔Prohibits physicians from referring patients to receive DHS payable by
Medicare or Medicaid from entities with which the physician or immediate family
member has a financial relationship unless an exception applies.
✔✔Stark-penalties - ✔✔Fines and exclusion from federal healthcare programs.
✔✔Stark-"Stand in shoes" - ✔✔DHS entity that owns or controls an entity to which a
physician refers Medicare patient for DHS. =A direct compensation arrangements.
✔✔Audit- "Retrospective Audit","Baseline Audit","Snap Shot Audit" - ✔✔Broad risk
assessment of all areas you need to
fix. Used to develop benchmarks.
✔✔Audit-
Concurrent Audit: - ✔✔Audit as issues arise then go back at 3,6 or more months to
follow up.
, ✔✔DRA-Deficit Reduction Act - ✔✔Provides states with flexibility over Medicaid
Programs . Can implement innovative ideas.
✔✔DRA-6044 - ✔✔Allows state Medicaid plans to mirror commercial insurance
packages through use of benchmark plans.
✔✔DRA-6041 &6042 - ✔✔States can vary the premiums and cost sharing . No
premiums are permitted for families with income above 100% and at/below 150% of
FPL. Also requires payment of alternative premiums as a condition of eligibility and
alternative cost sharing as a condition of receipt of the service or drug or cost sharing of
non-emergency services in ER. Not to exceed 5% of family income fir the month or
quarter period.
✔✔DRA-LTC =Long Term Care - ✔✔LTC Partnership is a unique combination of
private insurance and special access to Medicaid while still protecting assets.
✔✔DRA-MFP=Money Follows the Person - ✔✔Section 6071 supports states in
rebalancing LTC through 5 years if competitive grants that support targeted reforms to
strengthen community-based infrastructure
✔✔DRA- Transfer of Assets - ✔✔Sections 6011-6016 include several provisions to
discourage "Medicaid Planning".
✔✔DRA- Documentation of Citizenship - ✔✔Section 6036 requires states to obtain
proof of Citizenship and identity in order to receive Federal Financial Participation
(FFP).
✔✔DRA-Health Opportunity Accounts - ✔✔Section 6082 allows for 10 states to deliver
Medicaid benefits through an Health Opportunity Account (HOA) in combo with high
deductible health plans
✔✔DRA- 3rd Party - ✔✔Section 6035 enhance state's ability to find and recover 3rd
party liabilities primary to Medicaid
✔✔DRA-MIP=Medicaid Integrity Program - ✔✔Section 6032 requires entities that
receive or make payments of 5 mil annually to provide Federal False Claims Act
education to employees. MIP was formed by section 6034 with more resources for CMS
to use to fight Medicaid Fraud, Waste, & Abuse.
✔✔DRA-HCBS (Home and Community-Based Services) Waiver - ✔✔States can amend
their state plans to offer HCBS as a State Plan Optional Benefit (SPO) This allows
states to offer most services now covered under the waiver except "other services ".
New DRA option breaks eligibilty link between HCBS and institutional care.
SOLUTIONS RATED A+
✔✔FSG-Pervasiveness under subsection b. - ✔✔Case specific, depends on number
and degree of responsibility, of individuals within substantial authority personnel who
participated in,condoned, or were willfully ignorant of the offense.
✔✔Obstruction does not apply to - ✔✔Individuals hiding from organization
✔✔5 most important federal fraud and abuse laws - ✔✔*False Claims Act (FCA)
*Ant - kickback Statute (AKS)
*Physician Self-referral *Law (Stark I II III )
*Exclusion Authorities
*Civil Monetary Penalties Law (CMPL)
✔✔Stark - designated health services (DHS) - ✔✔*labs
*PT,OT,Outpatient Speech/Language Pathology
*Radiology, some other imaging
*Radiation therapy, supplies
*DME
*Parenteral enteral nutrients supplies
*Prosthetic Orthotic supplies devices
*Home Health services
*Outpatient Rx drugs
*Inpatient and Outpatient Hospital Services
✔✔Stark - strict liability - ✔✔Proof of intent not required to prosecute
✔✔Stark - ✔✔Prohibits physicians from referring patients to receive DHS payable by
Medicare or Medicaid from entities with which the physician or immediate family
member has a financial relationship unless an exception applies.
✔✔Stark-penalties - ✔✔Fines and exclusion from federal healthcare programs.
✔✔Stark-"Stand in shoes" - ✔✔DHS entity that owns or controls an entity to which a
physician refers Medicare patient for DHS. =A direct compensation arrangements.
✔✔Audit- "Retrospective Audit","Baseline Audit","Snap Shot Audit" - ✔✔Broad risk
assessment of all areas you need to
fix. Used to develop benchmarks.
✔✔Audit-
Concurrent Audit: - ✔✔Audit as issues arise then go back at 3,6 or more months to
follow up.
, ✔✔DRA-Deficit Reduction Act - ✔✔Provides states with flexibility over Medicaid
Programs . Can implement innovative ideas.
✔✔DRA-6044 - ✔✔Allows state Medicaid plans to mirror commercial insurance
packages through use of benchmark plans.
✔✔DRA-6041 &6042 - ✔✔States can vary the premiums and cost sharing . No
premiums are permitted for families with income above 100% and at/below 150% of
FPL. Also requires payment of alternative premiums as a condition of eligibility and
alternative cost sharing as a condition of receipt of the service or drug or cost sharing of
non-emergency services in ER. Not to exceed 5% of family income fir the month or
quarter period.
✔✔DRA-LTC =Long Term Care - ✔✔LTC Partnership is a unique combination of
private insurance and special access to Medicaid while still protecting assets.
✔✔DRA-MFP=Money Follows the Person - ✔✔Section 6071 supports states in
rebalancing LTC through 5 years if competitive grants that support targeted reforms to
strengthen community-based infrastructure
✔✔DRA- Transfer of Assets - ✔✔Sections 6011-6016 include several provisions to
discourage "Medicaid Planning".
✔✔DRA- Documentation of Citizenship - ✔✔Section 6036 requires states to obtain
proof of Citizenship and identity in order to receive Federal Financial Participation
(FFP).
✔✔DRA-Health Opportunity Accounts - ✔✔Section 6082 allows for 10 states to deliver
Medicaid benefits through an Health Opportunity Account (HOA) in combo with high
deductible health plans
✔✔DRA- 3rd Party - ✔✔Section 6035 enhance state's ability to find and recover 3rd
party liabilities primary to Medicaid
✔✔DRA-MIP=Medicaid Integrity Program - ✔✔Section 6032 requires entities that
receive or make payments of 5 mil annually to provide Federal False Claims Act
education to employees. MIP was formed by section 6034 with more resources for CMS
to use to fight Medicaid Fraud, Waste, & Abuse.
✔✔DRA-HCBS (Home and Community-Based Services) Waiver - ✔✔States can amend
their state plans to offer HCBS as a State Plan Optional Benefit (SPO) This allows
states to offer most services now covered under the waiver except "other services ".
New DRA option breaks eligibilty link between HCBS and institutional care.
