HCCA CERTIFICATION EXAM | 2026/2027
Health Care Compliance Association Certification Exam with Complete Questions & Verified Answers |
Latest Version
Overview
This 2026/2027 updated resource contains the latest Health Care Compliance Association
(HCCA) Certification Examination with the exact 150 questions and verified answers, following
current HCCA content specifications, OIG (Office of Inspector General) compliance guidelines, CMS
(Centers for Medicare & Medicaid Services) regulations, and evidence-based healthcare compliance
program standards across all domains.
Key Features
● ✓ Actual HCCA certification exam format with the official 150 questions
● ✓ Comprehensive coverage of all seven healthcare compliance domains
● ✓ Updated 2026/2027 federal healthcare regulations and enforcement trends
● ✓ Practical compliance program implementation scenarios
● ✓ Risk assessment and audit methodology applications
Core Content Areas (150 Total Questions)
● Healthcare Laws & Regulations (35 Qs)
● Compliance Program Standards & Operations (30 Qs)
● Fraud, Waste & Abuse Prevention (25 Qs)
● Risk Assessment & Auditing/Monitoring (25 Qs)
● Privacy & Security (HIPAA/HITECH) (20 Qs)
● Ethics & Professional Responsibility (10 Qs)
● Investigations & Enforcement Actions (5 Qs)
Detailed Content Breakdown
● False Claims Act & Anti-Kickback Statute Applications (15 Qs)
● Stark Law & Physician Self-Referral Regulations (12 Qs)
● CMS Conditions of Participation & Billing Requirements (15 Qs)
● OIG Compliance Program Guidance & Work Plans (12 Qs)
● Risk Assessment Methodologies & Tools (10 Qs)
● Auditing & Monitoring Program Development (10 Qs)
● HIPAA Privacy & Security Rule Implementation (15 Qs)
● HITECH Act & EHR Compliance Requirements (10 Qs)
● Corporate Integrity Agreement Requirements (8 Qs)
● Compliance Training & Education Programs (8 Qs)
● Conflict of Interest & Code of Conduct Implementation (10 Qs)
● Reporting & Disclosure Requirements (8 Qs)
● Board & Leadership Compliance Responsibilities (7 Qs)
● Enforcement Action Response & Remediation (10 Qs)
Answer Format
Correct answers are marked in bold green and include:
● Specific federal statute and regulation citations with applications
● OIG compliance program guidance element implementations
, ● Risk assessment scoring methodology calculations and interpretations
● Audit plan development and sampling methodology applications
● Privacy breach investigation and reporting protocol implementations
● Ethical decision-making frameworks for compliance dilemmas
Updates for 2026/2027
● 🔹
🔹 Reflects 2026-2027 HCCA content specification comprehensive revisions
●
● 🔹
🔹
Updated CMS regulatory changes and Medicare Advantage requirements
Enhanced telehealth compliance and digital health regulations
●
● 🔹
🔹
New price transparency and No Surprises Act implementation standards
Revised cybersecurity and ransomware response requirements
●
●
●
🔹 Updated enforcement priorities from DOJ, OIG, and CMS
🔹 New health equity and social determinants of health compliance considerations
Revised data analytics and predictive modeling in compliance monitoring
HCCA CERTIFICATION EXAM QUESTIONS (1–150)
1. Which federal law imposes liability for submitting false claims to federal healthcare
programs?
A. Stark Law
B. HIPAA
C. False Claims Act (31 U.S.C. §§ 3729–3733)
D. Anti-Kickback Statute
Rationale: The False Claims Act (FCA) holds individuals and entities liable for knowingly presenting
false or fraudulent claims for payment to federal programs like Medicare and Medicaid. It includes
treble damages and civil penalties (OIG Compliance Guidance, 2026).
2. Under the Anti-Kickback Statute (42 U.S.C. § 1320a-7b), which arrangement is most
likely a violation?
A. A hospital paying fair market value for physician services
B. A lab offering physicians $50 per patient referral
C. A group practice sharing overhead expenses
D. A health system providing free community screenings
, Rationale: The Anti-Kickback Statute prohibits knowingly offering, paying, soliciting, or receiving
remuneration to induce or reward federal healthcare program referrals. Per-patient payments
based on volume are per se violations (OIG, 2026).
3. The Stark Law (42 U.S.C. § 1395nn) primarily prohibits:
A. Physician self-referral for designated health services to entities with which they have
a financial relationship
B. Billing for services not rendered
C. Sharing patient data without consent
D. Employing unlicensed staff
Rationale: Stark Law is a strict liability statute that bans physician referrals for DHS (e.g., imaging,
lab, PT) to entities with which the physician (or immediate family) has a financial relationship,
unless an exception applies (CMS, 2026).
4. Which element is NOT one of the seven core components of an effective compliance
program per OIG guidance?
A. Written policies and procedures
B. Compliance officer and committee
C. Training and education
D. Mandatory arbitration for disputes
Rationale: The OIG’s seven elements include: (1) standards/policies, (2) compliance leadership, (3)
training/education, (4) effective lines of communication, (5) enforcement/disciplinary guidelines, (6)
auditing/monitoring, and (7) response/prevention. Arbitration is not a required component (OIG,
2026).
5. A compliance officer identifies a high-risk billing practice. The FIRST step should be to:
A. Report to law enforcement
B. Conduct an internal assessment and risk prioritization
C. Terminate the billing staff immediately
D. Ignore if revenue is high
, Rationale: Per HCCA and OIG standards, compliance professionals must first assess the scope,
severity, and risk level before determining the appropriate response, which may include internal
investigation, disclosure, or corrective action (HCCA Core Competencies, 2026).
6. Under HIPAA, a breach is presumed to have occurred unless the covered entity
demonstrates:
A. The data was encrypted
B. A low probability that PHI has been compromised (4-factor risk assessment)
C. The patient did not complain
D. The incident was unintentional
Rationale: Per 45 CFR § 164.402, a breach is presumed unless the covered entity performs a 4-factor
risk assessment (nature of PHI, unauthorized person, acquisition/viewing, mitigation) and proves a
low probability of compromise (OCR, 2026).
7. Which activity is required under a Corporate Integrity Agreement (CIA)?
A. Publicly naming whistleblowers
B. Engaging an Independent Review Organization (IRO) for claims review
C. Eliminating all physician relationships
D. Ceasing all Medicare billing
Rationale: CIAs, imposed by OIG as part of settlement agreements, typically require IRO reviews,
compliance training, reporting, and oversight to ensure adherence to federal healthcare program
rules (OIG, 2026).
8. The "No Surprises Act" (2020), effective 2026, primarily addresses:
A. Drug pricing transparency
B. Protection against balance billing for emergency and certain non-emergency services
C. Hospital infection rates
D. Telehealth licensing
Health Care Compliance Association Certification Exam with Complete Questions & Verified Answers |
Latest Version
Overview
This 2026/2027 updated resource contains the latest Health Care Compliance Association
(HCCA) Certification Examination with the exact 150 questions and verified answers, following
current HCCA content specifications, OIG (Office of Inspector General) compliance guidelines, CMS
(Centers for Medicare & Medicaid Services) regulations, and evidence-based healthcare compliance
program standards across all domains.
Key Features
● ✓ Actual HCCA certification exam format with the official 150 questions
● ✓ Comprehensive coverage of all seven healthcare compliance domains
● ✓ Updated 2026/2027 federal healthcare regulations and enforcement trends
● ✓ Practical compliance program implementation scenarios
● ✓ Risk assessment and audit methodology applications
Core Content Areas (150 Total Questions)
● Healthcare Laws & Regulations (35 Qs)
● Compliance Program Standards & Operations (30 Qs)
● Fraud, Waste & Abuse Prevention (25 Qs)
● Risk Assessment & Auditing/Monitoring (25 Qs)
● Privacy & Security (HIPAA/HITECH) (20 Qs)
● Ethics & Professional Responsibility (10 Qs)
● Investigations & Enforcement Actions (5 Qs)
Detailed Content Breakdown
● False Claims Act & Anti-Kickback Statute Applications (15 Qs)
● Stark Law & Physician Self-Referral Regulations (12 Qs)
● CMS Conditions of Participation & Billing Requirements (15 Qs)
● OIG Compliance Program Guidance & Work Plans (12 Qs)
● Risk Assessment Methodologies & Tools (10 Qs)
● Auditing & Monitoring Program Development (10 Qs)
● HIPAA Privacy & Security Rule Implementation (15 Qs)
● HITECH Act & EHR Compliance Requirements (10 Qs)
● Corporate Integrity Agreement Requirements (8 Qs)
● Compliance Training & Education Programs (8 Qs)
● Conflict of Interest & Code of Conduct Implementation (10 Qs)
● Reporting & Disclosure Requirements (8 Qs)
● Board & Leadership Compliance Responsibilities (7 Qs)
● Enforcement Action Response & Remediation (10 Qs)
Answer Format
Correct answers are marked in bold green and include:
● Specific federal statute and regulation citations with applications
● OIG compliance program guidance element implementations
, ● Risk assessment scoring methodology calculations and interpretations
● Audit plan development and sampling methodology applications
● Privacy breach investigation and reporting protocol implementations
● Ethical decision-making frameworks for compliance dilemmas
Updates for 2026/2027
● 🔹
🔹 Reflects 2026-2027 HCCA content specification comprehensive revisions
●
● 🔹
🔹
Updated CMS regulatory changes and Medicare Advantage requirements
Enhanced telehealth compliance and digital health regulations
●
● 🔹
🔹
New price transparency and No Surprises Act implementation standards
Revised cybersecurity and ransomware response requirements
●
●
●
🔹 Updated enforcement priorities from DOJ, OIG, and CMS
🔹 New health equity and social determinants of health compliance considerations
Revised data analytics and predictive modeling in compliance monitoring
HCCA CERTIFICATION EXAM QUESTIONS (1–150)
1. Which federal law imposes liability for submitting false claims to federal healthcare
programs?
A. Stark Law
B. HIPAA
C. False Claims Act (31 U.S.C. §§ 3729–3733)
D. Anti-Kickback Statute
Rationale: The False Claims Act (FCA) holds individuals and entities liable for knowingly presenting
false or fraudulent claims for payment to federal programs like Medicare and Medicaid. It includes
treble damages and civil penalties (OIG Compliance Guidance, 2026).
2. Under the Anti-Kickback Statute (42 U.S.C. § 1320a-7b), which arrangement is most
likely a violation?
A. A hospital paying fair market value for physician services
B. A lab offering physicians $50 per patient referral
C. A group practice sharing overhead expenses
D. A health system providing free community screenings
, Rationale: The Anti-Kickback Statute prohibits knowingly offering, paying, soliciting, or receiving
remuneration to induce or reward federal healthcare program referrals. Per-patient payments
based on volume are per se violations (OIG, 2026).
3. The Stark Law (42 U.S.C. § 1395nn) primarily prohibits:
A. Physician self-referral for designated health services to entities with which they have
a financial relationship
B. Billing for services not rendered
C. Sharing patient data without consent
D. Employing unlicensed staff
Rationale: Stark Law is a strict liability statute that bans physician referrals for DHS (e.g., imaging,
lab, PT) to entities with which the physician (or immediate family) has a financial relationship,
unless an exception applies (CMS, 2026).
4. Which element is NOT one of the seven core components of an effective compliance
program per OIG guidance?
A. Written policies and procedures
B. Compliance officer and committee
C. Training and education
D. Mandatory arbitration for disputes
Rationale: The OIG’s seven elements include: (1) standards/policies, (2) compliance leadership, (3)
training/education, (4) effective lines of communication, (5) enforcement/disciplinary guidelines, (6)
auditing/monitoring, and (7) response/prevention. Arbitration is not a required component (OIG,
2026).
5. A compliance officer identifies a high-risk billing practice. The FIRST step should be to:
A. Report to law enforcement
B. Conduct an internal assessment and risk prioritization
C. Terminate the billing staff immediately
D. Ignore if revenue is high
, Rationale: Per HCCA and OIG standards, compliance professionals must first assess the scope,
severity, and risk level before determining the appropriate response, which may include internal
investigation, disclosure, or corrective action (HCCA Core Competencies, 2026).
6. Under HIPAA, a breach is presumed to have occurred unless the covered entity
demonstrates:
A. The data was encrypted
B. A low probability that PHI has been compromised (4-factor risk assessment)
C. The patient did not complain
D. The incident was unintentional
Rationale: Per 45 CFR § 164.402, a breach is presumed unless the covered entity performs a 4-factor
risk assessment (nature of PHI, unauthorized person, acquisition/viewing, mitigation) and proves a
low probability of compromise (OCR, 2026).
7. Which activity is required under a Corporate Integrity Agreement (CIA)?
A. Publicly naming whistleblowers
B. Engaging an Independent Review Organization (IRO) for claims review
C. Eliminating all physician relationships
D. Ceasing all Medicare billing
Rationale: CIAs, imposed by OIG as part of settlement agreements, typically require IRO reviews,
compliance training, reporting, and oversight to ensure adherence to federal healthcare program
rules (OIG, 2026).
8. The "No Surprises Act" (2020), effective 2026, primarily addresses:
A. Drug pricing transparency
B. Protection against balance billing for emergency and certain non-emergency services
C. Hospital infection rates
D. Telehealth licensing
