HCCA CHC EXAM PREP QUESTIONS
AND ANSWERS GRADED A+ 2026
Stark or Physician Self-Referral Law - ANS The Omnibus Budget Reconciliation Act bans
physicians from referring patients to receive "designated health services" to any entity with
which the physician has a financial relationship. Designated health services include lab testing,
imaging services, physical or occupational therapy, etc. (civil only, medicare/medicaid only, strict
liability)
Anti-Kickback Statute (AKS) - ANS Prohibits the solicitation, receiving, offering, or paying any
remuneration directly or indirectly in cash or in kind in exchange. Essentially it prohibits the
exchange of anything of value in exchange for or in an effort to gain the referral of business
reimbursable by federal healthcare programs. (intent, any federal program, civil or criminal)
Physician Payments Sunshine Act (PPSA) - ANS Requires that detailed information about
payments or other "transfers of value" worth over $10 from manufacturers of drugs, medical
devices and biologics to physicians and teaching hospitals be made available to the public.
(Open payment data).
Deficit Reduction Act - ANS A Federal law that grants states the ability to modify their
Medicaid programs. This allows individual states to reform their Medicaid programs to fit with
the present health care environment while maintaining federal guidelines.
False Claims Act - ANS Originally adopted byt U.S. Congress to discourage suppliers from
overcharging the government, it is now legislation that prohibits anyone from knowingly
submitting or causing to be submitted a false or fraudulent claim. DOJ.
@COPYRIGHT 2026/2027 ALLRIGHTS RESERVED 1
, Qui Tam Action - ANS Allows persons and entities with evidence of fraud against federal
programs or contracts to sue the wrongdoer on behalf of the United States Government - based
upon private information.
7 Elements of an Effective Compliance Program - ANS 1. Policies and Procedures
2. Compliance Oversight
3. Effective Lines of Communication
4. Training / Education
5. Internal Monitoring and Auditing
6. Enforcing standards through consistent disciplinary guidelines
7. Responding timely to detracted offenses.
HIPAA Privacy Rule - ANS A covered entity may not use of disclose protected health
information except for when it is required or permitted.
HIPAA Security Rule - ANS Essentially outlines how to protect PHI in an electronic form (only
applies to ePHI). 3 main safeguards: administrative, technical, and physical.
Reportable Breach - ANS 1. breach of privacy rule
2. unsecured PHI
3. more than "low probability of compromise"
Breach Notification - ANS 1. Notify individual in writing
-if less than 10 are undeliverable, alternate notification method (like email) may be use
-if more than 10 are undeliverable, must post contact info to web page.
2. Must notify OCR within 60 days of the end of the calendar year
-if it involves 500+ people, must notify OCR immediately
@COPYRIGHT 2026/2027 ALLRIGHTS RESERVED 2
AND ANSWERS GRADED A+ 2026
Stark or Physician Self-Referral Law - ANS The Omnibus Budget Reconciliation Act bans
physicians from referring patients to receive "designated health services" to any entity with
which the physician has a financial relationship. Designated health services include lab testing,
imaging services, physical or occupational therapy, etc. (civil only, medicare/medicaid only, strict
liability)
Anti-Kickback Statute (AKS) - ANS Prohibits the solicitation, receiving, offering, or paying any
remuneration directly or indirectly in cash or in kind in exchange. Essentially it prohibits the
exchange of anything of value in exchange for or in an effort to gain the referral of business
reimbursable by federal healthcare programs. (intent, any federal program, civil or criminal)
Physician Payments Sunshine Act (PPSA) - ANS Requires that detailed information about
payments or other "transfers of value" worth over $10 from manufacturers of drugs, medical
devices and biologics to physicians and teaching hospitals be made available to the public.
(Open payment data).
Deficit Reduction Act - ANS A Federal law that grants states the ability to modify their
Medicaid programs. This allows individual states to reform their Medicaid programs to fit with
the present health care environment while maintaining federal guidelines.
False Claims Act - ANS Originally adopted byt U.S. Congress to discourage suppliers from
overcharging the government, it is now legislation that prohibits anyone from knowingly
submitting or causing to be submitted a false or fraudulent claim. DOJ.
@COPYRIGHT 2026/2027 ALLRIGHTS RESERVED 1
, Qui Tam Action - ANS Allows persons and entities with evidence of fraud against federal
programs or contracts to sue the wrongdoer on behalf of the United States Government - based
upon private information.
7 Elements of an Effective Compliance Program - ANS 1. Policies and Procedures
2. Compliance Oversight
3. Effective Lines of Communication
4. Training / Education
5. Internal Monitoring and Auditing
6. Enforcing standards through consistent disciplinary guidelines
7. Responding timely to detracted offenses.
HIPAA Privacy Rule - ANS A covered entity may not use of disclose protected health
information except for when it is required or permitted.
HIPAA Security Rule - ANS Essentially outlines how to protect PHI in an electronic form (only
applies to ePHI). 3 main safeguards: administrative, technical, and physical.
Reportable Breach - ANS 1. breach of privacy rule
2. unsecured PHI
3. more than "low probability of compromise"
Breach Notification - ANS 1. Notify individual in writing
-if less than 10 are undeliverable, alternate notification method (like email) may be use
-if more than 10 are undeliverable, must post contact info to web page.
2. Must notify OCR within 60 days of the end of the calendar year
-if it involves 500+ people, must notify OCR immediately
@COPYRIGHT 2026/2027 ALLRIGHTS RESERVED 2
