CPCO STUDY GUIDE
One of the most important elements of an effective compliance program is to have a
compliance officer or committee who is__________. - correct answer-empowered
If an employee, provider or anyone that deals with Federal or State healthcare dollars has
intent to receive payment for services not legitimately rendered this is considered
______________? - correct answer-fraud
Joan, as an employee of a healthcare organization, has _________to report erroneous
conduct, without repercussions, so that it may be corrected immediately - correct
answer-duty
person who exposes misconduct, alleged dishonest or illegal activity occurring in an
organization is called a______________? - correct answer-relator
The compliance program will flounder if employees of the organization are not aware of
_________? - correct answer-laws and regulations that pertain to their specific job
descriptions
When physicians (or their staff) make billing mistakes and errors the most important thing to
do is _________? - correct answer-Send a refund
Judy is the Compliance Officer for Apple Medical Group. The practice is a small group of
providers. Judy wants to have an open door policy as suggested by the OIG, thus she will? -
correct answer-Post notices of up-to-date compliance information on the employee bulletin
board
Participants in the Federal healthcare programs have an obligation to take measures, such
as instituting a compliance program, to _________________? - correct answer-detects and
prevent fraudulent, abusive and wasteful activities
Tim, the Compliance Officer for XYZ Community Hospital, should report to whom? - correct
answer-CEO or Board
The biller at XYZ Community Hospital wants to win the award every month for posting the
most insurance checks. Instead of giving the claims 30-60 days to clear, she bills them again
at the end of the month. This is an example of? - correct answer-double billing
The OIG has described seven basic components of an effective compliance program for a
small physician practice that are based from the _______________? - correct
answer-Federal Sentencing Guidelines
Kim, Compliance Officer for ABC Provider Group, created a compliance plan and policy a
year ago. While reviewing the groups Baseline Audits it comes to her attention that many of
the staff have decided NOT to follow the compliance plan. The Non-Compliance has
,____________? - correct answer-created a big risk of the group and Kim needs to make
sure that everyone knows about the risk of not following the compliance plan
A high-level statement or plan that embraces an organization's general beliefs, goals,
objectives and acceptable procedure for a specified subject area is a _______________? -
correct answer-policy
Kim is the Compliance Officer for ABC Provider Group. Kim has read the OIG Compliance
Program Guidance that acknowledges patient care as the first priority of a physician
practice. As the Compliance Officer (CO), Kim should implement what type of compliance
model? - correct answer-A "patients first"
It is important to educate employees of the methods they may utilize to directly notify and
communicate issues of suspected areas of non-compliance. What is considered a best
practice method of anonymous reporting? - correct answer-intra-office or USPS mail
Tim at XYZ wants to conduct a baseline audit to help determine? - correct answer-areas of
the billing department that might be in compliance
When the term Open Door Policy is used in reference to the Effective Communication, what
is this referring to? - correct answer-The Compliance Officer is accessible to all employees
via many methods of communication
When Kim from ABC Provider Group is conducting a risk assessment, one of the most
important and key sources of information that Kim as the Compliance Officer should utilize
is_____________. - correct answer-the Office of Inspector General's Annual Work Plan
The mission statement of the healthcare organization and a statement of why they are in
business are also known as _________? - correct answer-The Code of conduct
How often should the Tim, Compliance Officer for XYZ Community Hospital update the
compliance program and plan? - correct answer-As laws and regulations change; and at
least annually
After an employee receives their initial training regarding the practice/organization
Compliance Program what is the next step the compliance officer should take to protect the
practice against potential noncompliance activity? - correct answer-Perform a baseline
assessment of the employee's competency scores to determine if additional training is
required
ABC Provider Group and Apple Medical Group agree to pool their resources for the purpose
of accomplishing a specific task. This is called _____________. - correct answer-Joint
ventures
The following is not a level of non-compliance: - correct answer-Mistake in billing
For potential criminal violations, a practice should have immediate discussions with a
criminal attorney who - correct answer-Is well versed in Healthcare Fraud and Abuse law
,The Compliance Officer's main two responsibilities are to ____________the
practice/organization's compliance program. - correct answer-develops and then implement
Judy is the Compliance Officer for Apple Medical Group. The providers of the group ask
Judy to design a new Compliance Plan. Should Judy ask some other practices in town for a
copy of their Compliance Plan? Do all Compliance Programs have to be the same
regardless of the practice size or specialty? Why? - correct answer-No, compliance
programs need to be tailored to fit the unique needs of every organization or physician
practice
USSC is important as it related to the Federal Sentencing Guidelines and thus related to the
core elements of compliance. What does the USSC acronym stand for? - correct
answer-United States Sentencing Commission
Kathy, the Compliance Officer at a small provider office, is notified that a non-English
speaking patient will be arriving today. A LEP person/patient who needs an interpreter to
translate to and from the person's primary language must be provided. - correct answer-at
no cost to the patient or insurance carrier
In addition to hospitals, what other type of facility did the OIG provide supplemental
compliance program guidance for? - correct answer-Nursing Facilities
What is (are) considered a significant element(s) in fraud? - correct answer-Knowingly and
Intent
Department of Labor requires compliance with employee and employer laws including: -
correct answer-FLSA, OSHA, CRA, ERISA
Which government branch was created to fight waste, fraud and abuse in all federal health
care programs especially Medicare, Medicaid? - correct answer-Office of Inspector General
(OIG)
Dr. X is a very through provider. He always runs a full blood panel on each patient every year
for their physical. This is an example of: - correct answer-Waste
The current strategy for the DOJ includes all of the following except: - correct answer-Ensure
the privacy of patient records with the use of HIPAA
Which options are key elements for an effective Compliance Program?
I. Conducting external auditing and monitoring.
II. Implementing compliance and practice standards.
III. Designating a Compliance Officer or contact.
IV. Outsourcing appropriate training and education.
V. Responding appropriately to detected offenses and developing and implementing
corrective action.
VI. Developing open lines of communication.
, VII. Enforcing disciplinary standards through well-publicized guidelines. - correct answer-II,
III, V-VII
CPUP) The first large fraud case that involved a teaching hospital where Residents and
Fellows worked was located in: - correct answer-Pennsylvania
The Office of Evaluation and Inspections is part of what Agency or Department? - correct
answer-OIG
The hospital that John works for was just issued a CIA. What is the typical - correct
answer-five years
Kathy is thinking about specializing in healthcare compliance. Which entities below must
have a OIG compliance plan? - correct answer-a.
Laboratories, DME and Ambulance providers
b.
Home Health, Hospice and Nursing Homes
c.
Small and Large Provider Groups, Hospitals and Nursing Homes
Which component of the OIG has a duty of conducting audits, which result in reducing
waste, abuse, and mismanagement? - correct answer-Office of Audit Services
Kim is the Compliance Officer for a large provider group. One of the billers for the group
enters codes from the encounter form every evening before she goes home and then
finishes in the morning when she returns. She often enters an encounter twice. She usually
catches the mistake when the insurance checks are sent to the office and returns the
overpayment to the insurance carrier. This is an example of: - correct answer-Abuse
Which OIG office conducts criminal, civil and administrative investigations of fraud and
misconduct related to HHS programs, operations and beneficiaries? - correct answer-Office
of Investigations
Dr. A hires a nurse without looking to see if she was on the OIG's Excluded List. The nurse
had committed fraud in the past and was Excluded from working with any entity or individual
that uses Federal or State funds. Which of the statements below is true? - correct answer-Dr.
A will have to pay a CMP
The OIG Five Principal Strategy is made up of the following - correct answer-Enrollment,
Payment, Compliance, Oversight and Response
According to Inspector General Daniel Levinson, what can help reduce enforcement on a
provider from a CIA to a CCA? - correct answer-a robust and effective compliance program
What does the acronym LEP stand for? - correct answer-Limited English Proficiency
John works at a large hospital in the Compliance Department. He just heard that the hospital
was issued a CIA. What does CIA stand for? - correct answer-Corporate Integrity Agreement
One of the most important elements of an effective compliance program is to have a
compliance officer or committee who is__________. - correct answer-empowered
If an employee, provider or anyone that deals with Federal or State healthcare dollars has
intent to receive payment for services not legitimately rendered this is considered
______________? - correct answer-fraud
Joan, as an employee of a healthcare organization, has _________to report erroneous
conduct, without repercussions, so that it may be corrected immediately - correct
answer-duty
person who exposes misconduct, alleged dishonest or illegal activity occurring in an
organization is called a______________? - correct answer-relator
The compliance program will flounder if employees of the organization are not aware of
_________? - correct answer-laws and regulations that pertain to their specific job
descriptions
When physicians (or their staff) make billing mistakes and errors the most important thing to
do is _________? - correct answer-Send a refund
Judy is the Compliance Officer for Apple Medical Group. The practice is a small group of
providers. Judy wants to have an open door policy as suggested by the OIG, thus she will? -
correct answer-Post notices of up-to-date compliance information on the employee bulletin
board
Participants in the Federal healthcare programs have an obligation to take measures, such
as instituting a compliance program, to _________________? - correct answer-detects and
prevent fraudulent, abusive and wasteful activities
Tim, the Compliance Officer for XYZ Community Hospital, should report to whom? - correct
answer-CEO or Board
The biller at XYZ Community Hospital wants to win the award every month for posting the
most insurance checks. Instead of giving the claims 30-60 days to clear, she bills them again
at the end of the month. This is an example of? - correct answer-double billing
The OIG has described seven basic components of an effective compliance program for a
small physician practice that are based from the _______________? - correct
answer-Federal Sentencing Guidelines
Kim, Compliance Officer for ABC Provider Group, created a compliance plan and policy a
year ago. While reviewing the groups Baseline Audits it comes to her attention that many of
the staff have decided NOT to follow the compliance plan. The Non-Compliance has
,____________? - correct answer-created a big risk of the group and Kim needs to make
sure that everyone knows about the risk of not following the compliance plan
A high-level statement or plan that embraces an organization's general beliefs, goals,
objectives and acceptable procedure for a specified subject area is a _______________? -
correct answer-policy
Kim is the Compliance Officer for ABC Provider Group. Kim has read the OIG Compliance
Program Guidance that acknowledges patient care as the first priority of a physician
practice. As the Compliance Officer (CO), Kim should implement what type of compliance
model? - correct answer-A "patients first"
It is important to educate employees of the methods they may utilize to directly notify and
communicate issues of suspected areas of non-compliance. What is considered a best
practice method of anonymous reporting? - correct answer-intra-office or USPS mail
Tim at XYZ wants to conduct a baseline audit to help determine? - correct answer-areas of
the billing department that might be in compliance
When the term Open Door Policy is used in reference to the Effective Communication, what
is this referring to? - correct answer-The Compliance Officer is accessible to all employees
via many methods of communication
When Kim from ABC Provider Group is conducting a risk assessment, one of the most
important and key sources of information that Kim as the Compliance Officer should utilize
is_____________. - correct answer-the Office of Inspector General's Annual Work Plan
The mission statement of the healthcare organization and a statement of why they are in
business are also known as _________? - correct answer-The Code of conduct
How often should the Tim, Compliance Officer for XYZ Community Hospital update the
compliance program and plan? - correct answer-As laws and regulations change; and at
least annually
After an employee receives their initial training regarding the practice/organization
Compliance Program what is the next step the compliance officer should take to protect the
practice against potential noncompliance activity? - correct answer-Perform a baseline
assessment of the employee's competency scores to determine if additional training is
required
ABC Provider Group and Apple Medical Group agree to pool their resources for the purpose
of accomplishing a specific task. This is called _____________. - correct answer-Joint
ventures
The following is not a level of non-compliance: - correct answer-Mistake in billing
For potential criminal violations, a practice should have immediate discussions with a
criminal attorney who - correct answer-Is well versed in Healthcare Fraud and Abuse law
,The Compliance Officer's main two responsibilities are to ____________the
practice/organization's compliance program. - correct answer-develops and then implement
Judy is the Compliance Officer for Apple Medical Group. The providers of the group ask
Judy to design a new Compliance Plan. Should Judy ask some other practices in town for a
copy of their Compliance Plan? Do all Compliance Programs have to be the same
regardless of the practice size or specialty? Why? - correct answer-No, compliance
programs need to be tailored to fit the unique needs of every organization or physician
practice
USSC is important as it related to the Federal Sentencing Guidelines and thus related to the
core elements of compliance. What does the USSC acronym stand for? - correct
answer-United States Sentencing Commission
Kathy, the Compliance Officer at a small provider office, is notified that a non-English
speaking patient will be arriving today. A LEP person/patient who needs an interpreter to
translate to and from the person's primary language must be provided. - correct answer-at
no cost to the patient or insurance carrier
In addition to hospitals, what other type of facility did the OIG provide supplemental
compliance program guidance for? - correct answer-Nursing Facilities
What is (are) considered a significant element(s) in fraud? - correct answer-Knowingly and
Intent
Department of Labor requires compliance with employee and employer laws including: -
correct answer-FLSA, OSHA, CRA, ERISA
Which government branch was created to fight waste, fraud and abuse in all federal health
care programs especially Medicare, Medicaid? - correct answer-Office of Inspector General
(OIG)
Dr. X is a very through provider. He always runs a full blood panel on each patient every year
for their physical. This is an example of: - correct answer-Waste
The current strategy for the DOJ includes all of the following except: - correct answer-Ensure
the privacy of patient records with the use of HIPAA
Which options are key elements for an effective Compliance Program?
I. Conducting external auditing and monitoring.
II. Implementing compliance and practice standards.
III. Designating a Compliance Officer or contact.
IV. Outsourcing appropriate training and education.
V. Responding appropriately to detected offenses and developing and implementing
corrective action.
VI. Developing open lines of communication.
, VII. Enforcing disciplinary standards through well-publicized guidelines. - correct answer-II,
III, V-VII
CPUP) The first large fraud case that involved a teaching hospital where Residents and
Fellows worked was located in: - correct answer-Pennsylvania
The Office of Evaluation and Inspections is part of what Agency or Department? - correct
answer-OIG
The hospital that John works for was just issued a CIA. What is the typical - correct
answer-five years
Kathy is thinking about specializing in healthcare compliance. Which entities below must
have a OIG compliance plan? - correct answer-a.
Laboratories, DME and Ambulance providers
b.
Home Health, Hospice and Nursing Homes
c.
Small and Large Provider Groups, Hospitals and Nursing Homes
Which component of the OIG has a duty of conducting audits, which result in reducing
waste, abuse, and mismanagement? - correct answer-Office of Audit Services
Kim is the Compliance Officer for a large provider group. One of the billers for the group
enters codes from the encounter form every evening before she goes home and then
finishes in the morning when she returns. She often enters an encounter twice. She usually
catches the mistake when the insurance checks are sent to the office and returns the
overpayment to the insurance carrier. This is an example of: - correct answer-Abuse
Which OIG office conducts criminal, civil and administrative investigations of fraud and
misconduct related to HHS programs, operations and beneficiaries? - correct answer-Office
of Investigations
Dr. A hires a nurse without looking to see if she was on the OIG's Excluded List. The nurse
had committed fraud in the past and was Excluded from working with any entity or individual
that uses Federal or State funds. Which of the statements below is true? - correct answer-Dr.
A will have to pay a CMP
The OIG Five Principal Strategy is made up of the following - correct answer-Enrollment,
Payment, Compliance, Oversight and Response
According to Inspector General Daniel Levinson, what can help reduce enforcement on a
provider from a CIA to a CCA? - correct answer-a robust and effective compliance program
What does the acronym LEP stand for? - correct answer-Limited English Proficiency
John works at a large hospital in the Compliance Department. He just heard that the hospital
was issued a CIA. What does CIA stand for? - correct answer-Corporate Integrity Agreement
