HCCA Certified in Healthcare Compliance (CHC) Practice Exam

These questions are part of the practice quiz. Start practicing

• What defines a breach in the context of healthcare compliance?
• What is a primary benefit of implementing a compliance program in healthcare organizations?
• According to OIG's Self Disclosure Protocol (SDP), which of the following must be submitted?
• What must a provider do under Section 6402 of the ACA upon identifying an overpayment?
• Is a Business Associate required to have a contract with a Covered Entity to comply with HIPAA?
• When a hotline caller reports coding discrepancies, what should the compliance professional do first?
• True or False: CIA agreements can protect an organization from all forms of liability.
• What must be included in a covered entity’s Notice of Privacy Practices?
• Which of the following is NOT a permitted use of PHI?
• In what scenario can a covered entity disclose PHI for research without authorization?
• What is NOT one of the fiduciary duties of the board?
• What is the first action a compliance professional should take upon detecting wrongdoing?
• In a compliance investigation, what is the most important responsibility of the compliance professional?
• Which of these is NOT one of the six phases of a Corrective Action Plan (CAP)?
• What does LoProCo stand for in the context of HIPAA compliance?
• What is the recommended frequency for exclusion verifications according to compliance standards?
• What does the phrase "Res Ipsa Loquitur" mean in legal terms?
• When was the U.S. Federal Sentencing Commission organized, and when did it first publish its guidelines?
• Which entities are covered under the Physician Payment Sunshine Act?
• What is considered the first and best line of defense in compliance?
• During an investigation, why is it important to keep identities discreet?
• What should a research compliance professional do when an employee refuses a Hep B vaccination?
• As a new Compliance Officer, what should you do if the Code of Conduct is full of legal jargon?
• Are Business Associates required to comply with all Privacy Rules under HIPAA?
• What is an example of a contingency planning safeguard?
• If there are inconsistencies in PHI policies, what should the Compliance Officer do?
• What action should be prioritized if a privacy incident involving PHI is suspected?
• Which of the following is NOT required for an effective compliance program?
• In response to a call indicating potential research misconduct, what should the compliance professional assure the employee?
• What should be done in response to suspected misconduct or wrongdoing?
• Which entity cannot bill for medically unnecessary services?
• What is the purpose of the work product doctrine?
• The Health ____ _______ Administration encouraged the use of statistical sampling in Medicare claims. Fill in the blanks.
• If the DOJ declines to take on a qui tam case, what percentage can a whistleblower expect to receive from the total award?
• What can restitution to an identifiable victim include?
• A privacy official should inform a clinic that it can provide PHI to a researcher if the researcher:
• What is an example of a small organization according to FSG criteria?
• What are the three primary components of security according to the CIA triad?
• What key principle must be included in a non-retaliation policy for reporting compliance issues?
• What is the primary function of a company's Code of Conduct?
• What is the significance of the FSG Culpability Score?
• What is the main mission of the OIG?
• What is the consequence for violating EMTALA regarding patient treatment in an emergency?
• Which method is preferred for monitoring and auditing compliance effectively?
• Which of the following statements about de-identified health information is true?
• Which practice promotes a culture of compliance within healthcare organizations?
• What is one of the main purposes of the Code of Conduct?
• What is one consequence for providers who fully cooperate during an OIG self-disclosure?
• What is the next step for a privacy professional when receiving a hotline message about PHI misuse?
• What is a primary characteristic of monitoring in an organization?
• How can a Compliance Officer achieve higher levels of compliance engagement?
• What is the consequence of violating HIPAA regulations?
• What is a key feature of an effective compliance program?
• Which of these is NOT considered a common trigger for a compliance audit?
• Which type of safeguards are fundamental for protecting physical systems and data from environmental hazards?
• What does Willful Neglect refer to in compliance context?
• What does HITECH stand for?
• What does IACUC stand for?
• True or False: Underpayments identified during a CIA-Claim Review may be netted from overpayments.
• What does the acronym CPG stand for in the context of healthcare compliance?
• What is considered the most important aspect of a compliance program?
• What should the approach to penalties be based on?
• Which elements are effective for monitoring and auditing?
• Which of the following would be classified as a technical safeguard?
• What is the purpose of the response element in compliance?
• What is a core role of the Chief of Compliance in a healthcare organization?
• Is it permissible to send X-rays to a specialist without encryption?
• What is defined as Unsecured PHI?
• Which of the following comprises the entirety of a compliance program?
• What must a Business Associate obtain to claim compliance when selling an individual's PHI?
• Upon receiving a patient complaint about a research study invitation, what initial action is most appropriate?
• What is one function of safety data sheets in a hazard communication program?
• What action cannot be taken without having informed employees of rules and expectations?
• When creating and implementing a compliance plan, what is required of the compliance officer?
• Which of the following is NOT a category of privacy incident under HIPAA?
• An individual's understanding of the compliance aspects of their job can BEST be enhanced by including compliance in:
• RAT-STATS is best described as:
• In healthcare compliance, what does 'T' in TPO stand for?
• Which area should targeted compliance training specifically address?
• What was a primary reason for the enactment of the Sarbanes-Oxley Act?
• Which factor is key in defining the scope of a monitoring plan?
• What is one method used to monitor compliance?
• What is a penalty for willful neglect if the violation is corrected in 30 days?
• Which is an objective of HIPAA Administrative Simplification?
• Which of the following is not required in a written hazard communication program?
• What is one of the purposes of ongoing monitoring in a compliance program?
• How can organizations effectively perform community service in the context of probation?
• Which of the following is NOT considered part of the three C's of communication?
• Which of the following statements is true about the Sarbanes-Oxley Act?
• What is an essential component of PHI management in healthcare?
• Which type of medical record is destroyed by shredding and cutting?
• In responding to coding errors, what is a compliance professional's key responsibility?
• Which of the following is a common type of evidence collected for compliance violations?
• What is a critical element of a compliance professional's role when addressing a complaint's facts?
• Which Act requires providers to repay identified overpayments to Medicare and Medicaid within 60 days?
• What is a key factor for a healthcare organization to avoid unnecessary liability related to overpayments?
• What should be the outcome of conducting a baseline audit?
• What action warrants a civil penalty of $50,000 under HIPAA if not corrected within 30 days?
• In compliance program education, what should be the focus of scenario-based training?
• What is one significant benefit of maintaining communication lines open in a compliance program?
• Progressive discipline policies should be:
• What does the term 'treatment' in a healthcare context refer to?
• Who must comply with the HIPAA Privacy Rule?
• Which of the following is a benefit of conducting a Control Self-Assessment?
• What is an important first step in creating or improving a compliance team?
• Which of the following statements about the monitoring of internal controls is TRUE?
• Which of the following statements is true about the regulation of conflicts of interest in healthcare?
• Which individual goal is BEST for a privacy professional to include in their objectives?
• Who is eligible to bring a suit under the False Claims Act?
• What must a compliance program have in addition to a plan?
• If a referred patient has a hearing deficit, what should your practice do when scheduling an appointment?
• How is Medicaid primarily administered in the United States?
• Which aspect of compliance is essential for minimizing fraud risk?
• Which element is crucial for the effectiveness of compliance audits?
• What type of audit helps outline current operational standards in an internal assessment?
• True or False: The Public Health Service (PHS) defines a significant financial interest based on aggregated income exceeding $10,000 over a twelve-month period.
• When determining the extent of research monitoring activities, which factor is critical to consider?
• During a corporate compliance investigation, which statement is false regarding Attorney-Client Privilege considerations?
• When a provider receives a PHI request from Social Security Administration, what is the appropriate action?
• Which of the following is NOT a requirement under the HIPAA Security Rule?
• Which right is NOT included in the individual rights under the NPP?
• Which of the following best describes the watchwords for enforcing standards of conduct in compliance?
• What does a compliance committee primarily oversee?
• Where does the compliance professional typically find guidelines for developing compliance programs?
• Which of the following gifts is generally considered acceptable under a typical Code of Conduct?
• True or False: It is illegal under the Anti-Kickback Statute to provide free or discounted services to uninsured individuals.
• Which of the following is identified by CMS as a high-risk area for fraud?
• True or False: The STARK law prohibits Medicare payments for designated healthcare services referred by a physician with a financial relationship with the entity.
• Health information that cannot identify an individual is termed as?
• What is essential for compliance reporting regarding complaints?
• The purpose of EMTALA primarily aims to prevent what action by hospitals?
• What is a significant obstacle to effective compliance implementation?
• Which regulation should be reviewed in preparing an education session about lost thumb drives containing PHI?
• What is the scope of Chapter 8 of the Federal Sentencing Guidelines?
• In a compliance program, what does auditing and monitoring help ensure?
• What type of actions can the Office of Inspector General initiate according to healthcare compliance regulations?
• Which of the following is a responsibility under administrative safeguards?
• Which organization develops and administers standards relating to the well-being of workers at job sites?
• To assess the seriousness of a high error rate in claims, which type of sample should be pulled?
• When is it necessary to hire an outside consultant or legal counsel?
• What does a preventive internal control involve?
• A Compliance Program with well-written policies will not be successful without what?
• What is De-identified PHI?
• What is one responsibility that should NOT be handled by a compliance officer?
• At which level of the Medicare appeals process is the appeal reviewed by a qualified independent contractor?
• As a new compliance officer under an OIG CIA, what should be your first course of action?
• When handling a data breach, which law requires notification regarding the breach?
• What is a good starting point for monitoring compliance in an organization?
• One benefit of having an effective compliance program is to help create which of the following?
• Which accrediting body is recognized as the largest for healthcare organizations in the United States?
• What is an example of a physical safeguard?
• At its most basic level, what does a compliance program entail?
• What is the second step for a compliance professional upon detecting wrongdoing?
• What is a retrospective audit used for?
• What does the Physician Self-Referral Law prohibit?
• How many identifiers are listed in the HIPAA Privacy Rules?
• Which type of security standards involve the automated processes to protect data, such as encryption?
• What does the "reverse false claims" provision under FERA require from healthcare providers?
• Why is establishing compliance programs crucial for healthcare providers?
• Which safety measure should be included in a training presentation on privacy safeguards?
• What does Title I of the Genetic Information Non-discrimination Act (GINA) prevent?
• Which contractors are responsible for reviewing and paying claims for Medicare?
• Which act emphasizes the use of technology in health information?
• In the case of a 5-year CIA, which of the following statements is TRUE?
• When a PI is accused of accepting kickbacks from a sponsor, who should a research compliance professional FIRST notify?
• What should a department manager complete to ensure compliance with a new medical records policy?
• What destruction method is used for magnetic tape medical records?
• True or False: In the case of serious sensitive allegations, you should contact legal counsel to determine attorney-client privilege needs.
• What is true regarding contemporaneous reviews in a compliance setting?
• Under the Anti-Kickback Statute, what term refers to regulatory exceptions for specific joint ventures?
• What does risk assessment involve within an organization?
• Under Stark Law, what does "stand in the shoes" refer to?
• What is a likely consequence of the board not having a solid understanding of compliance objectives?
• What is the main purpose of a Remedial Order in probation?
• Which of the following describes the life cycle of records management?
• What does HIPAA require for disclosures of protected health information for treatment?
• Which of the following is NOT a typical role of the Board of Directors in compliance?
• What is one result of poor compliance management within an organization?
• What is one way to prevent duplication of auditing efforts in an organization?
• What does the Latin phrase "Qui tam pro domino rege quam pro se ipso in hac parte sequitur" mean?
• If several medical records are missing and physicians are taking original records home, what should the privacy professional do first?
• According to the Yates Memo, who may be held liable for corporate misconduct?
• What does the General Services Administration (GSA) manage?
• Which of the following is considered a strict liability statute?
• Does the HIPAA Privacy Rule cover all forms of protected health information including electronic, written, or oral?
• Which of the following could be a legal implication for an organization due to conflicts of interest identified through the Open Payments database?
• What does EMTALA require from participating hospitals regarding patient transfers?
• What year did OSHA establish the Bloodborne Pathogens Standard?
• What is the primary purpose of conducting a contemporaneous review in healthcare compliance?
• Which act established the Health Care Fraud and Abuse Control Program?
• Which statement is correct regarding the consequences of non-compliance?
• What defines the monetary gain for whistleblowers under the DOJ when it chooses to decline a case?
• What is the primary purpose of preventive controls within an organization?
• Which statement accurately describes the Response and Prevention Element in compliance?
• What does the Health Care Financing Administration (HCFA) encourage to promote consistency in interpretation of claims?
• What does the PhRMA Code prohibit?
• What is the first step in the monitoring and auditing two-step process?
• What is the maximum amount an employer can charge for personal protective equipment (PPE)?
• What does the Deficit Reduction Act (DRA) mandate regarding education on the False Claims Act (FCA)?
• What is the first step a Compliance Officer should take when developing goals for a review?
• What is the role of the Office for Human Research Protections?
• What regulates the circumstances under which a covered entity may use or disclose an individual's PHI?
• Which statement is TRUE regarding compliance programs?
• In the context of healthcare compliance, what does the term "fraud" refer to?
• Why would an organization want to listen to employees regarding compliance?
• What is the main purpose of general compliance training?
• What does the HCCA identify as two critical components of a compliance program?
• Which element is seen as an absolute necessity for a successful Compliance Program?
• What do the Federal Sentencing Guidelines (FSG) emphasize for corporations?
• How should an institution address a clause in a clinical trial agreement that gives the sponsor all rights to new interventions?
• What does the term "condoned" refer to in a compliance context?
• What is the primary function of HIPAA?
• What is included in "all the required safeguards" according to HIPAA?
• When under an imposed-CIA, which statement about Independent Review Organizations (IROs) is not true?
• An employee was terminated for accessing sensitive information. What is the privacy official's responsibility regarding disciplinary actions?
• True or False: The OIG advises the public on the governance of the PHRMA CODE.
• What does the term 'Code of Conduct' encapsulate in a healthcare organization?
• What is the purpose of EMTALA?
• What should a compliance program's goal focus primarily on from a monitoring perspective?
• Which key performance indicator is NOT typically monitored in compliance programs?
• When asked to approve a transfer form containing a patient's SS#, what should the privacy officer do first?
• What is the focus of the 2022 Monaco Memo regarding corporate governance?
• What is one of the main benefits of a Compliance Program?
• What are the seven basic elements for a fundamental compliance program?
• In analyzing a potential issue with provider services agreements and management contracts, what should the compliance professional consider?
• Which governmental body has the enforcement authority for HIPAA privacy?
• Which of the following is included in designated health services?
• True or False: Root cause analysis is a proactive activity performed after an incident has occurred.
• When a provider accidentally shares attorney-client privileged information with a third party, what is this considered?
• Which two main documents are essential for building a compliance program?
• When should the Code of Conduct be distributed to new employees?
• Which of the following is NOT a key to successfully creating a risk assessment team?
• What principle is emphasized in the Code of Ethics for Healthcare Compliance Professionals?
• What is a crucial element of corrective action plans (CAPs) following an audit?
• After an investigation that affects the organization's reputation, what should a Compliance Professional do next?
• How many states currently require nursing facilities to perform a background check of state records for direct-access employees?
• What does the acronym ACE signify in healthcare compliance?
• If there is a suspicion of prescription forgery for a controlled substance, what is the next step?
• What does the Quality Management Technique P-D-C-A stand for?
• What is the MOST appropriate action for an IRB upon receiving self-reported investigator non-compliance regarding inclusion criteria?
• What key aspect should be included in disciplinary action policies?
• Why is it advantageous for healthcare organizations to voluntarily implement compliance programs?
• What is the illegal practice of submitting separate claims for maximum reimbursement known as?
• What is another term for a Probe Audit or Probe Sample?
• In which scenario can a probe sample be used?
• Which statement regarding signed authorizations for release of information is correct?
• What is the consequence for organizations that fail to implement necessary compliance training?
• What does the Yates Memo emphasize regarding corporate misconduct?
• What is the classification of upcoding services to receive higher reimbursement from Medicare/Medicaid?
• After identifying non-systemic billing errors, what should be done next?
• What was the primary purpose of the False Claims Act (FCA) when it was implemented?
• Which action is voluntary for treatment, payment, and operations (TPO) under HIPAA?
• What historical context is associated with Lincoln's Law?
• What is the aim of conducting audits in healthcare organizations?
• If serious wrongdoing is suspected, what is the FIRST step to take?
• What element should a privacy professional consider first when presenting to the board about a privacy program?
• In emergency situations, what is true about PHI disclosure?
• What is a critical element to address when preparing a compliance plan for the year?
• According to the OIG Compliance Program Guidance, what should be articulated to demonstrate commitment to compliance?
• How long do providers have to refund overpayments once identified?
• What does PHI stand for?
• What aspect of compliance do Corporate Integrity Agreements primarily focus on?
• How can organizations reduce their culpability according to the Federal Sentencing Guidelines?
• Which of the following does NOT require authorization for the disclosure of PHI?
• Why is training and education critical in compliance programs?
• Which of the following is NOT a step in the audit process?
• What is the main purpose of the American Recovery and Reinvestment Act (ARRA)?
• What term is associated with the 2022 Monaco Memo in relation to corporate accountability?
• What is considered the primary means of minimizing employee exposure to hazards in the workplace?
• What is a critical responsibility of compliance training and education?
• What is one drawback of an internal reporting system?
• How often should compliance testing be performed?
• What is a key benefit of conducting a Controlled Self-Assessment?
• Which factors should be considered when establishing a frequency schedule for monitoring activities?
• What statement is true regarding the updating of a compliance program due to changing healthcare regulations?
• Which act aimed to eliminate discrimination based on race, religion, sex, or national origin in employment?
• If a whistleblower identifies fraudulent claims, what could be a true statement regarding potential rewards?
• What is a potential result of a willful violation of HIPAA?
• What is a key reason for implementing compliance training in healthcare organizations?
• What should you do if a patient walks into your practice with a leashed dog?
• Which of the following is an administrative safeguard?
• What should be included in a physician’s written policy regarding cash discounts?
• What is a formal statement outlining a plan for a specified subject area, usually citing state and/or federal required actions or standards?
• What is the significance of documenting how a complaint was handled?
• Before recommending disciplinary action for a nurse whose photo was posted online, what should the privacy professional determine?
• In the context of compliance, what role does a baseline audit play?
• What must be documented when amending a medical record?
• Under the US Federal Sentencing Guidelines, which process should be prioritized for effective compliance?
• What type of audit is characterized by a comprehensive inspection of records in anticipation of launching a compliance program?
• Which of the following elements is included in the Anti-Kickback Statute?
• If you become aware of a bribing situation, what is the proper course of action?
• Why is it important to have a written set of safety standards before an audit?
• What should be considered when designing practices for PHI confidentiality?
• In compliance, what does "education and training" primarily aim to achieve?
• Which of the following is NOT a consideration when determining what to do FIRST in applying regulations?
• What is the purpose of having billing policies in an organization?
• What term would be used for actions that result in unnecessary costs to the Medicare program?
• Which of the following actions is considered equally serious in terms of noncompliance?
• What is the process of identifying potential security risks and determining the probability and magnitude of risks called?
• How should an organization respond to an employee who does not complete compliance training?
• What does the HIPAA rule indicate about permissions versus requirements?
• What recent addition to compliance programs does the updated DOJ ECCP emphasize regarding new technologies?
• Which agency has enforcement authority for HIPAA privacy regulations?
• In relation to compliance, what is a critical function of leadership within an organization?
• What is the minimum number of units to be sampled for a full statistical audit?
• If a provider is dissatisfied with an informal review by the state Medicaid Program, what action can they take?
• A health system implemented an EHR in multiple clinics, and the privacy professional discovers inconsistent interpretations of access policies. What is the BEST strategy for the privacy professional?
• Where should enforcement of compliance begin according to best practices?
• Which of the following best describes the intent of a risk management strategy?
• Who is primarily responsible for carrying out discipline within a healthcare organization?
• What should a research compliance professional instruct a study coordinator regarding payment for recruitment in a clinical trial?
• What must any laboratory performing testing on human specimens do?
• What does PHI stand for in a healthcare context?
• Which organization has had the authority to levy administrative penalties for filing false claims since 1981?
• What should be done immediately regarding any identified compliance problems?
• Is a Security Risk Analysis required annually for a Covered Entity to comply with HIPAA?
• When can you use or disclose PHI?
• What is a key component that should be included in a compliance program according to the 2023 OIG guidance?
• Which of the following is an example of an administrative safeguard?
• What is the definition of "Deposition" in medico-legal terms?
• Which of the following accurately defines Medicare/Medicaid fraud?
• Which act contains the whistleblower provision?
• What is one potential incentive for self-disclosing misconduct to the OIG?
• Fundamentally, compliance efforts are designed to establish a ______ within a hospital that promotes prevention, detection, and resolution of conduct that does not conform to Federal and State law.
• At which level of the Medicare appeals process is an appeal decision made by the Office of Medicare Hearings and Appeals (OMHA)?
• Routine waiver of co-pays would violate which law?
• Which of the following can result in automatic disqualification of a relator from filing a qui tam action?
• The FSG - Culpability Score is used to determine what?
• What three checks does the OIG recommend for new employee policies?
• Which organization establishes written policies for Medicaid payment to prevent fraud, waste, and abuse?
• What is the maximum time allowed for reporting breaches affecting less than 500 individuals?
• Are physicians allowed to offer cash discounts?
• What is a potential result of an effective compliance program?
• What type of analysis evaluates the effectiveness of compliance efforts over time?
• Which of the following is a key component of a compliance program?
• What do Standards of Conduct written Policies and Procedures demonstrate?
• What is the significance of implementing the False Claims Act during the Civil War?
• What encompasses demographic information collected from an individual in healthcare?
• Which aspect is NOT part of the employee's responsibilities regarding the Code of Conduct?
• Restitution can be made in which of the following forms?
• What requires necessary policy measures to prevent avoidable recurrence?
• What is the minimum duration for which the OIG can impose a mandatory exclusion?
• Which of the following best describes engineering controls in safety management?
• What aspect of Medicare does Part A cover?
• What is one of the seven elements emphasized in OIG CPG guidance for hospitals?
• What is primarily emphasized for effective oversight in compliance programs?
• Which of the following are included as key performance indicators in compliance regulation and risk assessment?
• Which law does not require nursing facilities to conduct state FBI criminal background checks?
• What policy is implemented to foster open communication in a healthcare setting?
• What should be the focus of a healthcare organization's risk management strategy?
• Your organization recently completed a contemporaneous audit of laboratory billing practices and found that copays have been written off. What should be your next step?
• What type of services does Stark Law apply to?
• If a payment request from a diagnostic provider seems unusually high compared to others, what should you do?
• The Privacy Rule does not restrict the use or disclosure of _______________, which neither identifies nor provides a reasonable basis to identify an individual.
• Which statement correctly reflects the Stark Law's requirement for referrals?
• Which approach emphasizes support and correction for non-compliant behavior in enforcement?
• According to Stark Law, financial relationships are scrutinized if they exist between which of the following?
• In an informed consent, which statement is appropriate when a Pet scan is deemed non-billable?
• What is the purpose of Antitrust laws?
• Which of the following statements about attorney-client privilege is true regarding the billing manager's review?
• True or False: Communications between company counsel and employees are privileged, owned by the company.
• Which method is used to destroy laser disc medical records?
• In compliance training, what is the significance of providing a positive call for action?
• When should the compliance plan be reviewed?
• What must a healthcare provider set up to become a Medicare biller?
• What is the process to assess if an "impermissible" use of protected health information is a breach?
• What action should a compliance officer take if an ongoing investigation could be compromised by certain employees remaining present?
• What is the aim of the Physicians at a Teaching Hospital (PATH) review?
• True or False: If a serious allegation is sensitive in nature, legal counsel should be contacted to determine if Attorney Client Privilege (ACP) needs to be attached.
• Which law exempts self-insured health plans from state laws governing health insurance?
• The RICO Act is associated with increased penalties for violations related to which of the following?
• What does the “Upjohn warning” procedure entail?
• Which of the following provides legal protection from prosecution for a specific party?
• When does the 60-day timeline for breach notifications initiate?
• What kind of legislation is HIPAA considered?
• Which professionals are classified as physicians under Stark Law?
• How long are Corporate Integrity Agreements (CIAs) typically enforced?
• How long is a corporate integrity agreement typically enforced?
• What role does the Chief Compliance Officer play in an organization?
• Which of the following is considered an incidental disclosure of PHI?
• What is the look back period for Medicare overpayment claims?
• What should a compliance officer prioritize to enhance compliance in healthcare?
• What is a key goal of the Defense Industry Initiative?
• What is the primary purpose of a privacy exit interview?
• What does the acronym DOL represent?
• Protected health information (PHI) is considered de-identified by HIPAA Privacy Rule standards by:
• Which of the following best describes welfare benefit plans?
• Which action does NOT support a robust compliance program?
• How long does the Privacy Rule state that a practice or covered entity needs to retain medical records?
• What is the primary function of an Inspector General (IG)?
• What is a primary focus of concurrent audits?
• Which resources are MOST relevant for developing and updating a research compliance work plan?
• What is prohibited by the Omnibus Budget Reconciliation Act of 1987 (OBRA)?
• Which of the following levels of confidentiality is considered when handling personal health information (PHI)?
• In a compliance audit, the fieldwork step generally involves which activity?
• What is a potential requirement that the court may impose if future harm can be estimated?
• What does the Family Educational Rights and Privacy Act (FERPA) protect?
• What are Limited Data Sets used for within HIPAA guidelines?
• Which of the following describes a requirement for conducting a statistical sample in compliance reviews?
• What is the maximum penalty for noncompliance with HIPAA provisions?
• What is the function of risk assessment within a compliance program?
• Is root cause analysis a high priority among federal law enforcement and regulatory agencies during investigations?
• After implementing the non-retaliation policy, what should the compliance officer do next?
• What is NOT one of the basic elements of compliance monitoring?
• Which areas are common health care risk areas?
• In the risk assessment process, which step involves assessing risk tolerance information and inherent risk?
• Which entity is allowed to utilize a single notice of privacy practices?
• True or False: Employees may be required to give up their personal sense of right and wrong to function in the company.
• You are the new compliance officer at an institution with an established compliance committee. Which committee member's background would be most valuable in audit activities?
• What is a key function of the compliance officer in a healthcare organization?
• Which of the following practices supports the implementation of corrective actions after identifying compliance issues?
• What is the primary role of the US Sentencing Commission?
• What critical information must be included when notifying individuals of a breach?
• What is NOT a feature of CMS programs?
• What aspect of compliance management focuses on addressing both current and future risks?
• What is the correct term for physicians billing for services performed by residents in teaching hospitals?
• Can the same individual serve as both the designated privacy and security official under HIPAA?
• What type of audit is typically performed after transactions have been completed?
• What is a key difference between the Anti-Kickback Statute and Stark Law?
• When developing a privacy monitoring plan, where should the privacy professional initially focus?
• True or False: The Stark Law prohibits claims for designated health services based on tainted referrals.
• What are the types of sampling size characterized in audits?
• In what situation should immediate modification of procedures occur?
• Is it permissible for covered entities to use patient sign-in sheets as long as the disclosed information is limited?
• What is a Corporate Integrity Agreement (CIA)?
• What are the two instances in which PHI does not require authorization?
• Under HIPAA, who has the authority to define the roles of privacy and security officials?
• What should be taken into consideration when developing an audit agenda?
• What does an open door policy encourage in the workplace?
• Which of the following documents outlines the corrective action plan?
• When is protected health information (PHI) considered compromised?
• Which document is not typically associated with the self-disclosure process?
• Which term describes the 'provision, coordination, or management of health care and related services'?
• Under which circumstance can coinsurance and deductibles be waived?
• What is a Business Associate (BA) in healthcare?
• Which area is NOT commonly associated with healthcare fraud according to CMS?
• What action should organizations take if they discover a compliance violation?
• What identification is essential for employees in a compliance program?
• What is required for a subpoena to be valid?
• What organization develop standards and accredit hospitals and healthcare facilities?
• What is the scope of protection under GINA Title I related to?
• The DOJ's ECCP is part of which broader initiative?
• What does attorney-client privilege protect in the context of healthcare compliance reviews?
• What is necessary for senior management to adopt an effective compliance program?
• A written education plan for compliance should include which of the following?
• The Deficit Reduction Act requires providers receiving over $5 million in Medicaid funds to inform employees of their ability to?
• Which area is identified by the OIG as most prone to fraud, waste, and abuse in home health agencies?
• What type of information is NEVER acceptable to leave on an answering machine message?
• Who is primarily responsible for auditing and monitoring compliance risks?
• Who has the authority to impose a Corporate Integrity Agreement (CIA)?
• Which item is NOT required in a bloodborne pathogen training program?
• What type of law is the False Claims Act categorized as?
• What is one key benefit of a well-implemented compliance program?
• What Act created the Medicaid Integrity Program (MIP) to ensure that Medicaid payments are for covered services?
• What law can a healthcare organization violate by not returning overpayments within 60 days?
• What type of guidelines does the OIG describe its compliance program guidance as?
• According to HIPAA, what method can be used to de-identify PHI?
• Which compliance program guideline focuses on evaluating corporate compliance?
• What does GINA Title I allow health insurers to request?
• Which of the following is a valid example of PHI use beyond TPO?
• What is defined as electronically transmitted or maintained individually identifiable health information?
• Which federal agency's guidance includes criteria on unbiased judgment and independence for IROs?
• What is a key difference between consent and authorization under HIPAA?
• What does HIPAA stand for?
• Qui tam actions allow an individual to bring forward a claim to whom?
• Training requirements for compliance should include which essential component?
• What is the most important communication device for a compliance program?
• Before a government investigation occurs, which document should be reviewed carefully?
• What is a common consequence of non-compliance in healthcare organizations?
• True or False: The government only assesses financial compliance during audits and not other areas.
• What is the purpose of root cause analysis in healthcare compliance investigations?
• What is a primary function of the Compliance Officer?
• What is the source of notification requirements following a data breach of a clinical system containing PHI?
• How does EMTALA strengthen patient rights in emergency situations?
• What is NOT included in technical safeguards?
• Which agency is responsible for overseeing employee safety?
• What is a mitigating factor to a culpability score?
• Which section of the ACA prevents discrimination against individuals with limited English proficiency in healthcare programs?
• Which act imposes penalties for knowingly submitting false claims to Medicare?
• How do patients typically learn about their privacy rights under HIPAA?
• What impact does the Balance Budget Act of 1997 have on healthcare organizations with repeated fraud convictions?
• What is one role of the Compliance Committee according to regulatory guidelines?
• According to HIPAA, a healthcare provider or its business associate may disclose PHI when authorized to do so, but only to the extent necessary. This is known as:
• What can be a potential penalty under the False Claims Act?
• Which type of internal control is intended to signal the presence of a problem?
• What can a compliance professional use to quickly evaluate if more extensive audits are needed?
• Which type of monitoring review is designed to catch issues as they arise?
• What incentive may a provider receive for making a good faith Self-Disclosure to the OIG?
• What act requires annual adjustments of CMP fine amounts?
• Which statement reflects the importance of compliance programs in healthcare?
• Which of the following rights allows an individual to request limits on the use of PHI?
• What serves as an effective support system for the desired organizational culture?
• Which group is least likely to report errors in a healthcare setting?
• Which of the following is NOT listed as an obstacle to effective compliance program implementation?
• What encompasses any form of identifiable health information maintained by a healthcare provider or agency?
• What is the primary purpose of progressive discipline according to OIG recommendations?
• What can be said about self-reporting as a mitigating factor?
• What is the Teaching Physician Rule primarily concerned with?
• What is the primary purpose of OIG’s Voluntary Self-Disclosure Protocol?
• If a facility only performs blood draws and no testing, does it require a CLIA number?
• What is the primary function of the Qui Tam provision?
• What type of audit should be conducted for historical data analysis?
• Under what circumstances can PHI be disclosed without patient authorization?
• Which of the following have been identified as high-risk areas by the OIG?
• What type of audit is most likely used to identify the amount of repayment to Medicare for specific claims?
• Which aspect does NOT typically form part of a compliance program's structure?
• What must compliance and ethics programs ensure according to the Federal Sentencing Commission?
• What kind of safeguards might include the use of visitor badges and surveillance cameras?
• What does the anti-kickback statute prohibit?
• How often are workforce retraining sessions mandated by the HIPAA Privacy Rule?
• What is the "Caremark Duty" related to?
• Which of the following can help reduce the risk of a qui tam lawsuit?
• What consequence can result from violations of the Anti-Kickback Statute?
• When can a patient instruct their provider not to share treatment information with their health plan?
• When was the False Claims Act implemented?
• True or False: A compliance program that never identifies problems is considered to be effective.
• In-kind payments as restitution may include which of the following?
• What are Corporate Integrity Agreements negotiated between?
• What is an Independent Review Organization (IRO) responsible for in Corporate Integrity Agreements?
• What role does a compliance officer typically fulfill in a healthcare organization?
• Which Act of 2003 was established to reduce medication errors due to illegible physician handwriting and to promote e-prescribing?
• What can lead to the detection of errors in past billing practices?
• What does the Medicaid - Deficit Reduction Act of 2005 allow states to do?
• What does the FSG Culpability Score measure?
• What does PHI stand for?
• Which of the following is NOT a part of the Code of Conduct content checklist?
• Which of the following conditions is associated with the imposition of community service as part of probation?
• The compliance professional’s role in risk management includes which of the following?
• What is one characteristic of the "safe harbors" established by the OIG in the AKS?
• Why is the Caremark International Derivative Litigation significant?
• What is one of the main reasons cited for reinforcing employee’s innate sense of right and wrong through compliance programs?
• What is one of the main benefits of an effective compliance program?
• True or False: The OIG's Self-Disclosure Protocol can be utilized to disclose illegal arrangements related to the Anti-Kickback Statute (AKS) and Stark Law.
• If a provider is on the OIG sanctions list, what is the first step to take?
• What is the role of proper documentation in compliance, according to HHS-OIG?
• What is the meaning of TPO in the context of HIPAA?
• HHS is primarily responsible for which aspect of public welfare?
• What significant action is referred to as "Qui Tam" under the FCA?
• What does a compliance program fundamentally involve?
• What is the general principle behind the HIPAA Privacy Rule?
• What is the main difference between HIPAA Privacy and Security?
• What should a healthcare organization do to ensure it is compliant with HIPAA regulations?
• What does the Physician Payment Sunshine Act require manufacturers to disclose?
• Which document should serve as a reference for information about personnel policies and procedures?
• Which term best describes the approach to punishment of the Federal Sentencing Guidelines (FSG)?
• What is the acceptable extrapolation of the review results for the Observation Room charges?
• Which type of audit identifies potential errors before the process is completed?
• Part B of Medicare primarily covers which type of services?
• False Claims Act violations can result from which other types of violations?
• In CMS identified areas of high-risk fraud, which combination does NOT apply?
• Who is responsible for investigating potential overpayments in a healthcare organization?
• What is a sign of failed efforts to use statistical analysis in sampling?
• What is indicated by the acronym POA?
• When resolving compliance issues, which aspect is emphasized as the most critical line of defense?
• Which is not one of the seven fundamental elements of an effective compliance program?
• Organizations can reduce their culpability according to the Federal Sentencing Guidelines by?
• Which of the following is an obstacle to an effective compliance program?
• If there is a detection of serious wrongdoing, what is the first step for the compliance professional?
• What are the three main responsibilities of hospitals under EMTALA when a patient arrives at the emergency department?
• What does the acronym C.I.A. stand for in the context of HIPAA?
• Compliance audits typically relate to which of the following functions?
• What category of security standards includes delegation of security responsibilities and security training?
• What might documentation in a criminal or civil trial include?
• Which of the following is considered a compliance activity in many organizations?
• What is the primary purpose of the Health Care Compliance Association (HCCA)?
• What is the compliance professional's best action when confirming that PHI was posted on social media?
• Which designated health services are covered by the Stark Law?
• Which of the following elements is considered absolutely essential for the success of a compliance program?
• Which of the following is NOT a governmental investigative tool?
• What measure is most important for prevention in a compliance program?
• If wrongdoing is identified, what is the FIRST action to take if an overpayment is found?
• Which legislation mandates compliance programs for Medicare, Medicaid, and CHIP providers?
• What is a benefit of using stories and analogies in training?
• Which of the following is NOT an offense that could lead to OIG exclusion from Federal health care programs?
• A covered entity must obtain the patient's written authorization for any use or disclosure of protected health information (PHI) in which circumstances?
• Before developing a Compliance Program, what should be conducted first?
• What type of arrangement might lead to OIG identifying an "outlier" for non-compliance?
• What is the main objective of conducting compliance reviews in healthcare billing?
• A compliance audit typically aims to do which of the following?
• True or False: OIG voluntary guidance is intended to enhance internal controls within organizations.
• What agency developed the Federal Sentencing Guidelines (FSG)?
• In HIPAA, which subpart deals with Security?
• What is required for an "addressable" implementation specification?
• What is Part D of Medicare mainly focused on?
• What is the maximum prison sentence for committing a HIPAA offense knowingly?
• Before conducting a safety audit in an emergency department, what is the first item needed?
• What should a compliance professional do first upon receiving a complaint about unfair discipline?
• True or False: The OIG requests that organizations disclose their adherence to the PHRMA CODE on their website.
• How should a compliance professional assess the effectiveness of a training program?
• Which resource should clinical lab providers review to understand compliance requirements?
• What document must be provided to patients that outlines their rights regarding PHI?
• What characteristic should disciplinary mechanisms possess to be effective?
• Which of the following best describes compliance program structure's importance?
• Which subpart in Part 164 of HIPAA deals specifically with Privacy?
• Which is a key goal of establishing a code of conduct in healthcare organizations?
• True or False: An individual has unrestricted access to all PHI within their Designated Record Set (DRS).
• Which of the following is not one of the key objectives of internal controls?
• Who has the authority to bring civil action under the False Claims Act?
• Which of the following is NOT considered a possible sanction by the OIG?
• What does the HITECH Act primarily promote?
• What is the maximum number of years a retrospective audit may need to cover due to the False Claims Act?
• What does a directive internal control aim to do?
• In what order should the sample sizes of different audit types be ranked from least to most?
• Which of the following is a task that a Chief Compliance Officer should NOT focus on?
• What cycle is part of continuous improvement as per compliance practices?
• What should a privacy officer do after identifying a deficiency in the Notice of Privacy Practices (NPP)?
• What is the primary purpose of the False Claims Act (FCA)?
• What does a Fiscal Intermediary do in the context of Medicare and Medicaid services?
• What must be established by entities receiving more than $5 million in annual Medicaid payments?
• What does ERISA stand for?
• Which question is considered the most effective to include in an employee exit interview?
• Who does the OIG urge to assist in the implementation of the compliance program?
• What should organizations develop to effectively document compliance risks?
• Which of the following options aligns with the foundation of an effective compliance program?
• What does HIPAA Administrative Simplification aim to achieve?
• What is a primary benefit of conducting a contemporaneous review?
• What is a significant benefit of a Corporate Compliance Program?
• What should the Privacy Officer do after learning about a lost encrypted USB drive containing sensitive PHI?
• Who can request an OIG Advisory Opinion?
• In the context of healthcare compliance, what plays a critical role in monitoring Medicare fraud?
• In providing appointment reminders to patients, what should an organization address in their notice of privacy practices (NPP)?
• What is the primary focus of the general compliance training session?
• Who is allowed to file a complaint under the False Claims Act?
• What is another name commonly used for the Stark Law?
• When determining the amount of a civil money penalty for HIPAA violations, which factor is NOT considered?
• Which of the following is not an aggravating factor to a culpability score?
• What is the first step in developing an annual compliance audit?
• Which of the following is NOT included in the five important federal fraud and abuse laws?
• In an audit of billing practices, which statement about sampling is INCORRECT?
• Under FERA, what may happen if overpayments are not returned in time?
• Which of the following statements accurately reflects the attitude of ACA regarding statistical sampling?
• What is the focus of GINA?
• Which of the following is NOT a characteristic of a Corporate Integrity Agreement (CIA)?
• Which element is essential within the compliance department to foster compliance culture?
• What does a contemporaneous review involve in compliance auditing?
• When should a breach be considered discovered?
• The HIPAA Security Rule requires a covered entity to implement policies and procedures for authorizing access to e-PHI only when such access is appropriate based on the user or recipient's role. True or False?
• What was Chapter 8 of Federal Sentencing Guidelines designed for?
• In the context of a compliance program assessment, what key factor should be reviewed related to the prevention of fraud, waste, and abuse?
• What should compliance programs include to understand and mitigate risk?
• In which situation can the information of a deceased patient be released to the spouse?
• Which principle should guide the compliance professional throughout an investigation?
• What is one method in managing risk in an organization?
• In order to determine the required sample size for a statistical review, what factor must be considered?
• What role does Compliance play in a disciplinary action?
• What type of testing requires a laboratory to enroll in the CLIA program?
• In a healthcare compliance setting, what is an example of behavior that could be considered reckless non-compliance?
• Which of the following is NOT a criterion for home health coverage?
• Is it true that Risk Management aligns with Quality Management in determining measures for risk avoidance and prevention?
• Is it permissible for healthcare practices to remind patients of their appointments?
• Which area is NOT subject to the 250-yard zone rule under the definition of "hospital campus"?
• What should be done to maintain the confidentiality of information during an investigation?
• What does the acronym CIA stand for in healthcare compliance?
• What comprises a Designated Record Set (DRS) under HIPAA?
• What does the Sunshine Act mandate regarding pharmaceutical and medical device manufacturers?
• What does Attorney-Client Privilege protect?
• What should a facility's policy be when contacted for patient information by an agency investigating a HIPAA privacy violation?
• Which statement best describes the concept of "integrity" as it relates to compliance programs?
• What is the penalty for a HIPAA violation committed under false pretenses?
• In the compliance framework, how should compliance professionals approach risk communication?
• How are microfilm medical records typically destroyed?
• Which behavior is classified as unethical?
• What does the oversight function of the Board of Directors entail?
• Which action demonstrates a commitment to compliance in a healthcare setting?
• What is the deadline for reporting breaches affecting 500 or more individuals?
• What is the appropriate response to a spelling error in a patient's medical record?
• Which component is key for preventing unethical behaviors in an organization?
• When a medical record is inconsistent with the selected diagnosis code, who should the coder contact?
• The compliance program should address plans to verify adherence to applicable laws through what methods?
• What is the primary focus of the Office of Inspector General (OIG) in healthcare compliance?
• One of the operations in healthcare includes reviewing the competence of providers. What classification does this operation fall under?
• Compliance risk management professionals should design a framework to ensure management understands?
• Why should compliance officers set disciplinary policies for non-compliance?
• The ACA requires that all providers adopt a compliance plan as a condition of enrollment with Medicare, Medicaid, and CHIP. Is this statement true or false?
• What does the investigation final report in documentation include?
• Are incidental disclosures allowed under the HIPAA Privacy Rule?
• What is the purpose of Project Bad Bundle?
• What types of tools are commonly utilized in government investigations?
• What is the first priority of the Justice Department according to its stated priorities?
• What is the primary function of the CMS (Centers for Medicare and Medicaid Services)?
• True or False: The 2023 OIG Compliance Program Guidance requires organizations to conduct periodic compliance risk assessments at least annually.
• When assisting IT with data privacy controls, which of the following is an employee-related control?
• What does a compliance program primarily aim to enforce within an organization?
• What is a critical first step in the compliance auditing process?
• What significant event does February 27, 1997, represent in the context of healthcare compliance?
• What is described as a multi-step process in progressive discipline?
• What type of training should a compliance professional provide to meet learning styles of doctors and nurse practitioners?
• What does the Breach Notification under ARRA require covered entities to do?
• If a hospital's discovery sample reveals a financial error rate above 5%, what does the OIG require?
• Who is primarily responsible for clinical trial billing compliance and enforcement?
• What is the focus of a risk assessment in compliance?
• What kind of actions might lead to a penalty of $100,000 for a HIPAA violation?
• What are the two agencies that the Healthcare Fraud and Abuse Control program requires to coordinate federal, state, and local healthcare law enforcement activities?
• Which of the following is NOT a category of obligations in the HCCA Code of Ethics?
• What outcome might occur if errors in billing are not promptly addressed?
• What type of actions may be subject to discipline according to compliance standards?
• What is a key difference between enforcement and discipline in a compliance program?
• Which law does not require proof of intent for violations?
• When training physicians and providers, which aspects should be covered?
• What document does the OIG develop if a provider does not have a corporate integrity agreement in place?
• What does the Defense Industry Initiative aim to improve?
• What is the purpose of the compliance program element referred to as Investigation/Mitigation/Non-Employment of Sanctioned Individuals?
• Which statement is true about patient rights under HIPAA?
• What legal obligation does the receiving CE have when a misdirected fax is sent?
• What aspect of healthcare does HITECH Subtitle D focus on?
• What is considered an appropriate start to implementing an effective compliance program for small physician group practices with limited resources?
• In a compliance program, the focus should primarily be on what aspect?
• When developing a compliance work plan, what does prioritizing physician contract management indicate?
• True or False: Conducting a Controlled Self-Assessment contributes to increasing the awareness and targeting of audit work.
• A covered entity must designate a ___________________ who is responsible for developing and implementing its security policies and procedures.
• In research compliance, what is a primary goal of an IRB?
• Who should be contacted immediately upon discovering a significant billing error?
• What does P-D-F stand for in the context of audits and investigations?
• Which of the following is NOT a purpose of a Business Associate in healthcare?
• Which of the following is one objective of a baseline audit?
• According to the OIG, what is equally important to the successful implementation of a compliance program?
• How should complaints received through a Compliance Hotline be handled?
• Which of the following statements are true regarding the Statute of Limitations under the False Claims Act?
• Which regulation requires hospitals to provide medical screening exams regardless of insurance?
• In dealing with medical necessity issues, whom should the compliance professional collaborate with?
• What should be considered when evaluating a potential conflict of interest?
• Conducting what type of sample would indicate potential issues within a compliance framework?
• What is the effective consequence of HIPAA of 1996 regarding incorrect claims?
• What can be a potential consequence of intentional or reckless non-compliance?
• What type of training sessions should a compliance professional conduct?
• What are primary safety concerns in the medical setting?
• Examples of proper disposal methods of protected health information (PHI) may include:
• How long can a corporate integrity agreement last at maximum?
• What are the primary focus areas of a Board of Directors (BOD) concerning compliance?
• Effective enforcement and discipline elements include:
• Which of the following describes an effective compliance program in terms of quality of care?
• Which of the following describes one of the roles of a board member?
• An effective auditing/monitoring plan must consider what factor?
• In which context is the term "Physician Self-Referral" used?
• Which of the following is included in the elements of a compliance program?
• True or False: Randomness in sampling is crucial for representativeness.
• When monitoring a high-risk area shows it was never implemented, what should the compliance professional do FIRST?
• Which of the following is an example of healthcare operations?
• What outcome does the OIG expect from documented findings in compliance activities?
• Under which condition can PHI be disclosed for research purposes?
• Is encryption required under HIPAA?
• Which Act safeguards student educational records from unauthorized uses and disclosures?
• What underlying goal does root cause analysis serve?
• Which type of audit takes place in real-time?
• Which Compliance Program Element is emphasized by the statement "the only thing worse than not having a policy is having a policy and not following it"?
• Code of conduct supersedes which of the following?
• Which law provides protection against discrimination in employment based on genetic information?
• Which of the following is included as a Covered Entity?
• What is the main focus of Title II of GINA?
• Which type of information is NOT considered part of the Electronic Protected Health Information (ePHI)?
• What is indicated by cooperation with government investigators in compliance matters?
• Which type of information is specifically associated with the payment for healthcare services?
• What does "Willfully Ignorant of the Offense" imply?
• What is a common objective of an effective compliance program?
• Which document is essential for a laboratory performing high-complexity testing before a compliance review?
• What are two of the mitigating factors according to the Federal Sentencing Guidelines?
• What is defined as an emergency medical condition according to EMTALA?
• Which training topic specifically addresses risks associated with privacy breaches?
• In healthcare compliance, why is effective education and training emphasized as a key element?
• How are minor unintentional non-compliance infractions typically addressed?
• What does OSHA stand for in the context of healthcare compliance?
• True or False: A vendor that stores encrypted copies of files from a covered entity is not a Business Associate because the ePHI is unreadable.
• How many criteria must be met before a patient can be transferred to another facility under EMTALA?
• What can help establish a positive compliance atmosphere within an organization?
• What is the primary goal of maintaining the integrity of medical records?
• True or False: A self-audit can help providers reduce chances of non-compliance.
• Which of the following is NOT one of the five most important federal fraud and abuse laws?
• What governs the HIPAA Security Rule?
• What is one of the main responsibilities of a Compliance Officer?
• How is the sample size related to probe audits?
• What is a characteristic of an effective HR policy within a healthcare organization?
• True or False: An excluded individual is automatically reinstated at the end of an exclusion term.
• Which standard component is NOT typically included in codes of conduct?
• According to recent regulations, compliance programs must include written policies and what other core element?
• According to the content, which factor is essential for developing effective compliance programs?
• Which of the following is a primary goal of compliance programs in healthcare organizations?
• What was the main goal of the 1984 Sentencing Reform Act?
• Which certificate allows a laboratory to conduct moderate- to high-complexity testing until compliance is determined?
• What is the recommended frequency for general compliance training for employees, physicians, and volunteers?
• How long is PHI protected after the person's death?
• Which of the following is a benefit of having a compliance program?
• How many percutaneous injuries involving contaminated sharps occur annually according to CDC estimates?
• The majority of fraud and abuse violations are related to which of the following?
• What does the acronym OIG stand for in the context of healthcare compliance?
• Under what condition can a relator not pursue a qui tam action?
• The term OIG refers to which of the following organizations?
• Which definition correctly describes Medicare/Medicaid abuse?
• Which of the following statements best defines Reasonable Diligence in compliance?
• Which of the following best describes an inadvertent violation of privacy?
• What is a consequence of transferring a patient under EMTALA without appropriate medical records?
• If there's an employment issue that requires compliance intervention, what is the next step?
• What is the primary contribution of auditing and monitoring to a compliance program?
• When should counsel be involved during an internal investigation?
• In what year was the Equal Employment Opportunity Commission created?
• In case of a cyber-attack, what steps must an entity take?
• According to the Equal Employment Opportunity law, what is a protected characteristic?
• What workforce size typically qualifies as a large organization under FSG?
• What does Stark Law aim to prevent?
• What is the purpose of internal controls in an organization?
• In the context of healthcare compliance, what characterizes 'waste'?
• If a provider receives a tainted referral, what is the main consequence under the Stark Law?
• What is the most effective delivery method for compliance content as recommended?
• Which of the following actions reflects a breach of ethical standards in research?
• Which of the following is noted for involving some of the largest breaches reported to HHS?
• What can ongoing monitoring help identify in a compliance program?
• When implementing a compliance plan, what is required for approval?
• Which characteristic defines a Statistical Valid Sample?
• Which of the following is true about the monetary settlement a relator can receive in qui tam actions?
• What is a key item that can protect a medical practice from harassment liability?
• What does the acronym SDN represent in healthcare compliance?
• According to HHS-OIG, what is one important reason for proper documentation in compliance?
• If a co-worker leaves a PC logged into the confidential system, what is the best action?
• When conducting disciplinary actions related to privacy violations, what is crucial for consistency?
• Which statement is true regarding compliance programs?
• Which of the following is NOT a legal requirement under the Equal Employment Opportunity law?
• Which of the following situations requires authorization for PHI disclosure?
• Which elements should be included in policies regarding enforcement and disciplinary actions?
• What is the aim of the Physician Payment Sunshine Act in relation to public transparency?
• What is an essential characteristic of an engaging compliance training session?
• What is the first step when potential issues are identified within an organization?
• What is an effective strategy to demonstrate compliance with personnel policies?
• What should a billing manager do if a significant error is identified in the billing process?
• When anticipating what the government will measure during a compliance program review, which of the following should you consider?
• What does the False Claims Act primarily address?
• True or False: Upcoding has been a major focus of OIG's enforcement efforts, and HIPAA added another civil monetary penalty for upcoding violations.
• What are the two primary objectives of a Board of Directors (BOD)?
• When is the HIPAA Privacy Rule retraining of the workforce required?
• What is primarily assessed during the evaluation of compliance program effectiveness?
• What crucial element is first called for in OIG guidance for compliance programs?
• What are the three benefits of an effective compliance program?
• Which of the following best describes the nature of a Compliance Program?
• What is the primary purpose of attorney-client privilege?
• Which of the following questions is NOT useful during an internal investigation?
• Which of the following is NOT typically included in codes of conduct?
• Why is it important to conduct a retrospective audit?
• True or False: Unintentional billing mistakes and overpayments do not need to be reported to the OIG's SDP.
• Which of the following is NOT a regulatory agency that identifies compliance risks?
• A PI testing a hypothesis with de-identified medical records should first:
• What is a primary source of information for the team conducting an audit?
• What is a common measure to mitigate privacy risk when sharing patient information?
• What are the three types of internal controls?
• Which principle is essential for handling PHI?
• True or False: The Anti-Kickback Statute applies to referrals from patients.
• What should be readily accessible to all coding staff?
• What general areas does an OCR investigation examine?
• What does the term "Duty of Care" refer to for a Board of Directors (BOD)?
• What does the Anti-Kickback Statute safe harbors protect?
• What does 'upcoding' refer to in medical billing?
• Under EMTALA, what is required from hospitals when a patient arrives in the emergency department?
• What element is significant for a compliance program in relation to healthcare fraud?
• Which procedure must be included in a policy for statistically valid sampling if the financial error rate exceeds 5%?
• Which regulation aims to enhance safety protocols in compliance programs?
• A covered entity may disclose protected health information (PHI) without a patient's written permission for:
• HITECH is an integral part of which legislative act aimed at economic recovery?
• In GINA Title II, what is illegal for employers to use for employment decisions?
• Who benefits financially from a Qui Tam suit if successful?
• In the context of compliance, what would a follow-up phase typically involve?
• Which privacy law pertains to the protection of financial information?
• What does the acronym OHCA stand for?
• What type of safeguard is NOT included in the HIPAA Security Rule?
• What type of act is the False Claims Act, which offers incentives for whistleblowing?
• Which of the following is a key responsibility of a privacy professional?
• Why is it important for all members of a healthcare organization to participate in the compliance program?
• What compelling reason supports the continuation of an auditing program?
• What is the ongoing process called that management performs to ensure processes are effective?
• What approach is NOT one of the primary methods for Controlled Self-Assessment?
• Which characteristic is most important for a Compliance Professional in a newly acquired hospital?
• Which term represents the process of identifying and dealing with risks in a compliance program?
• What type of training does OIG suggest should be a separate session and targeted?
• What should a compliance professional do to prevent a billing error from recurring after it has been identified?
• What is the Stark Period of Disallowance?
• When is immediate notification to the government warranted according to OIG compliance guidance?
• What is a fundamental principle of the Privacy Rule?
• Which statement about breaches is correct?
• When is a breach assumed to be reportable?
• What type of rewards does the FSG suggest offering to those who adhere to compliance and ethics programs?
• Which action is essential once compliance violations are identified?
• Which of the following is considered a substantial risk for health care compliance?
• Which option should be considered for disclosing a violation of federal fraud laws?
• Which act requires providers to be permanently excluded from federal health care programs after being found guilty of fraud three times?
• What is the primary purpose of a compliance committee?
• Which of the following principles addresses the obligation to the public?
• What is a significant fear that can hinder an effective compliance program?
• What principle states the obligation of compliance professionals to serve their organization with integrity?
• Incentive programs based on employee performance may be tied to increases in what?
• Which acronym refers to legal protections between a lawyer and a client?
• Which process focuses on identifying and addressing problems as they occur?
• Which criminal offense is OIG required to exclude individuals from Federal health care programs for?
• What is the difference between an addressable and a required implementation specification under HIPAA?
• How are computerized data medical records destroyed?
• Which entity administers the Medicare and Medicaid laws outlined in the Social Security Act?
• A violation of PHI is considered a breach when:
• Paying a hospital monthly rent significantly below fair market value would be a violation of which regulation?
• How can auditing be distinguished from monitoring in a compliance context?
• What are the four impermissible acts associated with a HIPAA breach?
• What does the acronym LEIE refer to?
• What does HITECH Subtitle A focus on?
• Which agency is referred to by the acronym OCR?
• True or False: Organizations are requested to indicate their adherence to the PHRMA CODE on their websites.
• Why is developing a variety of educational materials important?
• Which part of the HIPAA rules applies to PHI in all formats?
• According to US Courts, which of the following is NOT included in the obligations concerning statistical sampling for overpayment estimations?
• Which of the following is considered an Anti-Kickback Statute violation?
• What is a grand jury subpoena used for in a government investigation?
• The Privacy Rule provides two de-identification methods. Which of the following is NOT one of them?
• According to compliance best practices, which is the primary factor for effective compliance communication?
• What does the False Claims Act empower the government to do?
• What are the suggested development guidelines for compliance programs issued by the OIG called?
• What type of information encompasses health information related to the health condition of an individual?
• What significant reforms did the Balance Budget Act of 1997 introduce concerning Medicare and Medicaid?
• Which of the following best illustrates the importance of diverse educational materials?
• When developing a compliance program, which of the following actions should be prioritized after risk assessment?
• If an IACUC manager identifies studies with lapsed approvals, what should the research compliance professional do?
• What is a direct result of a Stark violation?
• What is a requirement for auditors in the context of compliance?
• What was established by the DRA of 2005?
• A record retention policy must be based on which of the following?
• When a compliance officer finds an excluded provider has treated patients, what is the NEXT action they should take?
• In the context of healthcare compliance, what is the impact of proving intent under the Anti-Kickback Statute?
• Which type of healthcare service management may include consultation between providers?
• In which scenario should a compliance professional establish attorney-client privilege?
• What key principle underlies the regulations enforced by the US Sentencing Commission?
• To effectively manage compliance, what should the Compliance Officer ensure is in place?
• Which of the following is a preventive measure to avoid a Qui Tam lawsuit?
• Which aspect of HIPAA aims to maintain the integrity of personal health information?
• What is the outcome of failing to adhere to compliance programs?
• Which method is NOT used to destroy paper medical records?
• How frequently is the IACUC required to conduct an inspection of a vivarium?
• Who holds the primary responsibility for the monitoring component of internal controls?
• Which of the following should be reflected in a billing company's written policies and procedures?
• What should the Chief Compliance Officer do first when faced with increased correspondence challenging medical necessity?
• What role does in-house legal counsel play in healthcare compliance reviews?
• Who is considered an immediate family member under the Stark Law?
• What is the best first step for a compliance professional when an employee reports unequal disciplinary action?
• One of the benefits of a Compliance Program is to:
• Which of the following is NOT identified as a special area of OIG concern?
• What types of records are excluded from the Designated Record Set (DRS) under HIPAA?
• What type of information does the CMS Open Payments Program provide to the public?
• What should compliance professionals do in response to discovering a systemic billing error?
• What does RAT-STATS provide for auditors?
• Which option is a federal oversight related to Medicaid?
• What is a key feature of a Non-Statistical Sample?
• What is the time frame for protecting PHI after an individual’s death?
• Boards have vital roles in Compliance; which aspect is NOT among their responsibilities?
• What type of communication is NOT considered PHI?
• What main purpose does a subpoena serve in a compliance investigation?
• Which scenario violates the Stark Law?
• What is essential for a privacy professional to maintain in order to keep up with industry standards?
• What does Section 6401 of the Affordable Care Act specify about compliance programs?
• What should be done with a "required" implementation specification under HIPAA?
• Which of the following is the first step to take upon discovering a violation of federal fraud and abuse laws?
• Which of the following is a method for collecting compliance data?
• The Office of Inspector General (OIG) is a division of which agency?
• What should you do if you discover a minor inventory discrepancy in controlled substances?
• What should you do if certain employees are not being properly disciplined for misconduct?
• What is the purpose of a hotline or helpline in compliance monitoring?
• If someone did not know about a HIPAA violation, what is the potential civil penalty?
• Which document is used to assist employees in carrying out daily responsibilities within an appropriate legal standard?
• Which of the following actions could lead to termination as a consequence of non-compliance?
• Regarding Compliance Program effectiveness, which statement is NOT true?
• What is ensured by contract provisions for background checks of vendor employees?
• Which of the following is a key component of training requirements for compliance?
• In compliance investigations, why is it important to engage with outside counsel?
• For what purpose should an investigation and necessary disciplinary action be taken if a limited data set is released?
• What legal consequence can occur if Medicare overpayments are not refunded?
• How often are CIAs required to undergo regular monitoring?
• How many states require nursing facilities to perform FBI checks on employees?
• On what basis should the compliance committee typically develop objectives and goals?
• True or False: The PHRMA CODE is a law that must be followed by organizations.
• Are providers liable for fraud committed by their billing services without their knowledge?
• Which organization is represented by the acronym EEOC?
• How often should providers check if employees are on the OIG List of Excluded Individuals after hiring?
• What step should be taken when considering self-disclosure of a potential fraud issue?
• When is a covered entity permitted to use or disclose PHI for marketing purposes?
• Which three qualities should communication to staff about compliance matters possess?
• The most important lines of defense for a compliance program is?
• What does RAT STATS refer to in the context of healthcare compliance?
• What should be included in a comprehensive compliance program?
• What should a compliance professional's NEXT step be if they identify payments to physicians for medical directorships without written contracts?
• What is considered a violation when billing for items or services?
• What does the OIG's voluntary self-disclosure protocol require providers to report?
• What are the four areas PHI can be used or disclosed by?
• What action should be taken if there’s a directive from an immediate supervisor that conflicts with compliance protocols?
• What is a common reason cited for the failure to implement compliance programs in healthcare?
• Which of the following does NOT fall under Attorney-Client Privilege?
• Which statement accurately describes fraudulent billing?
• What is the focus of the Anti-Kickback Statute?
• Which of the following describes an organization with an effective compliance program?
• What term describes an organization's commitment to compliance by management, employees, and contractors?
• In the context of healthcare compliance, the concept of 'Operations' primarily includes which of the following?
• What is the contact number for the OIG's Fraud and Abuse hotline?
• Which law creates liabilities for submitting false claims to federal healthcare programs?
• What type of test would be practical for a physician practice to determine unpaid claims?
• Under HIPAA's Privacy Rule, who constitutes the covered entity's workforce?
• What is a key characteristic of a Covered Entity?
• What key element must compliance programs include according to US Sentencing Guidelines?
• Which document outlines high expectations for organizational compliance programs as per the latest DOJ guidance?
• Which of the following is NOT a necessary policy or procedure for organizations?
• Which category of privacy is primarily concerned with health records under HIPAA?
• What is the MOST important training topic for investigators in a research compliance educational session?
• What is one of the first actionable items after establishing a compliance program?
• What right is NOT typically included in the Notice of Privacy Practices?
• What is the primary goal of a compliance program?
• How should education for minor infractions be approached?
• What is one potential risk of failing to address overpayments found during a review?
• What are the two types of OIG exclusions?
• According to the Federal Sentencing Guidelines, which factor could increase an organization's punishment?
• Which third-party plays a critical role in accurate billing and reimbursement?
• What does the acronym CIA stand for in a compliance context?
• What should a privacy professional do first if an employee reports potential illegal activity involving misuse of identifiable information?
• What does Part C of Medicare refer to?
• Is there currently legislation specifically regulating artificial intelligence systems?
• What do SURS or SUR Units refer to?
• What safeguards are included in the HIPAA Security Rule?
• What is the lowest potential federal civil monetary penalty for a HIPAA violation?
• A health care provider needs permission to notify public health authorities of a reportable disease occurrence. Is this statement true or false?
• What should your first course of action be if a provider and secretary are found violating privacy regulations?
• The HIPAA Privacy Rule covers which of the following?
• According to the Balance Budget Act of 1997, what is the "three strikes" rule associated with?
• For what reason might education not be labeled as punishment?
• Which process aims to identify the effectiveness of internal controls in place?
• In a research study involving adolescents, what document must an adolescent subject sign?
• What is the correct method for destroying DVD medical records?
• What is the record retention period for HIPAA-related work products?
• According to the OIG Compliance Program Guidance, how should patient care be seen in relation to compliance programs?
• What is the FIRST action an employee should take when an investigator presents a search warrant?
• If a compliance professional discovers non-compliance, what is the FIRST step they should take?
• What is an essential component in establishing a culture of compliance within an organization?
• Under what circumstances can a covered entity disclose PHI without authorization?
• Why was the Bloodborne Pathogens Standard introduced by OSHA?
• In the course of an audit, what is the first course of action if disciplinary actions against certain individuals are found to be unfair?
• What is Attestation in a compliance context?
• What should be done after clarifying a suspected fraud violation?
• What is the best course of action after receiving an OHRP letter regarding a specimen bank without IRB approval?
• Which area of concern primarily deals with billing processes in healthcare compliance?
• Which agency indicates a self-evaluation after the discovery of potentially fraudulent acts?
• Does a Compliance Officer impose disciplinary actions within an organization?
• Which of the following actions is critical when conducting a claim review under a CIA?
• How should an organization view expenses related to the compliance program?
• True or False: Expanding contemporaneous reviews to include retrospective reviews is beneficial for providers.
• In a compliance program, what is essential for risk assessment?
• Which agency emphasized that compliance and ethics programs should be designed to prevent and detect criminal conduct?
• How should reporting systems within healthcare organizations be handled?
• What percentage of the government's total award can a relator receive if the DOJ intervenes in a qui tam action?
• Which of the following describes the types of audits?
• What is one of the requirements of the Gramm-Leach-Bliley Act concerning financial institutions?
• What does 'P' in TPO refer to in the context of healthcare?
• If Leaf Hospital conducts a contemporaneous review, what might they uncover that warrants further action?
• Why are regular compliance training sessions important?
• Who should primarily participate in the development of goals and objectives for the compliance program?
• What is the first step one should take when establishing an effective compliance program?
• What is necessary for a successful reporting method in compliance?
• What is the recommended minimum annual training duration suggested by OIG for compliance?
• How can a 100% confidence level in an audit be obtained?
• What does the acronym SURS stand for?
• What should a research compliance professional do NEXT after discovering device and serial numbers included in reporting data during a HIPAA audit?
• According to HIPAA, can pharmacists provide advice about over-the-counter medicines without restriction?
• What documentation is NOT critical for a Compliance Officer's review when opening files?
• What type of feedback mechanism can reinforce positive behavior in compliance?
• Is it true that experienced compliance health care personnel can perform "double duty" as trainers and line performers?
• Upon identifying a potential violation, what should be done first?
• What does the OIG suggest should be included in a compliance program regarding discipline?
• Why should a supervisor explain the Code of Conduct to employees?
• Which part of HITECH is dedicated to funding grants and loans?
• Which of the following is a consequence of failing to comply with federal health care regulations?
• Does HIPAA allow disclosure of protected health information about a student to a school nurse for treatment purposes?
• Which of the following two statements regarding RAT-STATS are true?
• Which of the following is a key aspect of compliance awareness among employees?
• Which of the following is a focus of the Federal Sentencing Commission's 2004 changes?
• Who is responsible for enforcing the rules and regulations under Medicare and Medicaid laws?
• Who is primarily responsible for reviewing policies and procedures related to compliance in an organization?
• Which of the following actions shows ethical leadership in a healthcare setting?
• Which of the following is a key activity related to 'Payment' in the TPO framework?
• SNFs are Medicare certified facilities that provide extended skilled nursing or rehabilitative care. This care is reimbursed under which Medicare part(s)?
• Which of the following is NOT a risk management process?
• What is a vital part of fostering compliance culture in healthcare organizations?
• Which of the following is a primary responsibility of a compliance officer according to the OIG?
• What law should a physician be educated about if they signed a clinical trial agreement and requested funds for referrals?
• How is a retrospective audit characterized?
• What is the purpose of the Health Care Fraud and Abuse Control Program?
• Which of the following expenses related to compliance programs is NOT considered tax deductible?
• What is the least important qualification for a Compliance Officer in your organization?
• What is the role of the Compliance Officer regarding department policies?
• What should a compliance officer do if they discover a potential violation?
• True or False: An email request from a client is sufficient authorization for secure communication.
• OIG believes that the Compliance Program should include a written policy statement addressing what?
• What action should be included in the education plan regarding content areas?
• Which statement is false regarding the financial error rate in a Claim Review under a CIA?
• What is a Health Care Clearinghouse?
• Who conducts and supervises audits and investigations for federal agencies?
• The Privacy Rule generally requires covered entities to limit uses, disclosures, or requests of PHI to the minimum necessary to accomplish the intended purpose. True or False?
• What was the primary purpose of the Sarbanes-Oxley Act of 2002?
• Which of the following is NOT a typical consideration in compliance policy reviews?
• If an employee violates the non-retaliation policy by spreading rumors, the compliance professional's first action should be?
• Which of the following is a key requirement of the Sunshine Act?
• What subpart governs Breach Notifications in HIPAA?
• What should be included in the provider self-disclosure to the government?
• What is considered one of the most important foundations of a compliance program?
• What type of control is exemplified by the requirement to purchase from approved suppliers?
• What could happen to a physician who fails to respond to an emergency while on call?
• What is a significant outcome of performing a thorough risk assessment?
• How often must new employees be trained about HIPAA regulations?
• Which of the following is part of preventive measures in compliance?
• A billing manager notices a 50% increase in Federal health care program payments. What should be the NEXT step?
• What term is used for Federal regulations that specify certain joint ventures concerning hospitals and/or physicians that are compliant with Medicare laws?