Certified Healthcare Compliance - CCB
Exam ACTUAL QUESTIONS AND
CORRECT ANSWERS
EEOC - CORRECT ANSWERS✅✅Equal Employment Opportunity Commission -
employment and labor laws.
ERISA - CORRECT ANSWERS✅✅Employee Retirement Income Security Act -
regulations, wage and hours rules.
OSHA - CORRECT ANSWERS✅✅Occupational Safety and Health Administration -
Nuclear regulatory commission.
JCAHO - CORRECT ANSWERS✅✅Joint Commission on Accreditation of Healthcare
Organizations
What is a compliance program - CORRECT ANSWERS✅✅prevent, detect, collaborate and
enforce.
OIG - CORRECT ANSWERS✅✅Office of Inspector General - enforces rules and
regulations under that Medicare and Medicaid laws.
AG - CORRECT ANSWERS✅✅Attorney General
Benefits of a Compliance Program - CORRECT ANSWERS✅✅1. Demonstrate to
employees and the community the org commitment to good conduct.
2. ID and prevent criminal and unethical conduct.
3. Improve the quality of patient care.
4. Create a centralized source of information on health care regulations.
5. Develop a methodology that encourages employees to report potential probs.
6. Develop procedures that allow the prompt, thorough investigation of alleged misconduct.
7. Initiate immediate and appropriate corrective action.
,8. Reduce the orgs exposure to civil damages and penalties, criminal sanctions, and
administrative remedies.
CIA - CORRECT ANSWERS✅✅Corporate Integrity Agreement
Reasons to Implement CRP - CORRECT ANSWERS✅✅1. demonstrates to community that
provider has a strong commitment to honesty and responsible corporate citizenship.
2. reinforce employees' innate sense of right and wrong.
3. Helps provider fulfill its legal duty to govt and private payors.
4. Cost effective in the long run.
5. More accurate view of employee and contractor behavior relating to fraud and abuse.
6. Enhanced quality of patient care.
7. Provides procedures to promptly correct misconduct.
8. Mitigate any sanctions imposed by the govt.
9. Voluntarily implementing is better than govt imposed any day!
10. May protect corporate directors from liability.
HIPAA - CORRECT ANSWERS✅✅Health Insurance Portability and Accountability Act of
1996 - criminal offense to submit false claims. Also states we will protect patient
information.
False Claims Act - CORRECT ANSWERS✅✅govt may investigate and bring civil action
against providers found submitting incorrect claims on purpose.
Whistle Blower - CORRECT ANSWERS✅✅Qui Tam
Federal Sentencing Guidelines - CORRECT ANSWERS✅✅guidance for assessing fines is
designed so that sanctions imposed upon orgs and their ages, will provide just punishment,
adequate deterrence and incentive for orgs to take action.
Culpability Score - CORRECT ANSWERS✅✅Calculation of fines that adds points for
aggravating factors and subtracts points for mitigating factors.
, Culpability Score Aggravating Factors - CORRECT ANSWERS✅✅1. upper level employee
has participated in, condoned or willfully ignorant of the offense.
2. violation is a repeat offense.
3. govt was hindered during investigation.
4. awareness of and tolerance of violation were pervasive.
Culpability Score Mitigating Factors - CORRECT ANSWERS✅✅1. org have an effective
CRP
2. org reported the violation promptly
3. org cooperated w/govt investigation
4. org accepted responsibility.
Seven Elements of CRP - CORRECT ANSWERS✅✅1. Written standards of conduct
2. Designated a chief compliance officer
3. effective education and training
4. audits/evaluation techniques to monitor compliance.
5. reporting process/procedures for complaints.
6. appropriate disciplinary mechanisms
7. investigation and remediation of systemic problems.
10 Obstacles of Effective Implementation - CORRECT ANSWERS✅✅1. commitment and
buy in
2. funding
3. too many hats to be worn by individual(s)
4. interpreting laws and regulations
5. lack of resources/ staff
6. lack of education and training
7. resistance to change
8. lack of/poor communication
9. fear of retaliation/retribution
Exam ACTUAL QUESTIONS AND
CORRECT ANSWERS
EEOC - CORRECT ANSWERS✅✅Equal Employment Opportunity Commission -
employment and labor laws.
ERISA - CORRECT ANSWERS✅✅Employee Retirement Income Security Act -
regulations, wage and hours rules.
OSHA - CORRECT ANSWERS✅✅Occupational Safety and Health Administration -
Nuclear regulatory commission.
JCAHO - CORRECT ANSWERS✅✅Joint Commission on Accreditation of Healthcare
Organizations
What is a compliance program - CORRECT ANSWERS✅✅prevent, detect, collaborate and
enforce.
OIG - CORRECT ANSWERS✅✅Office of Inspector General - enforces rules and
regulations under that Medicare and Medicaid laws.
AG - CORRECT ANSWERS✅✅Attorney General
Benefits of a Compliance Program - CORRECT ANSWERS✅✅1. Demonstrate to
employees and the community the org commitment to good conduct.
2. ID and prevent criminal and unethical conduct.
3. Improve the quality of patient care.
4. Create a centralized source of information on health care regulations.
5. Develop a methodology that encourages employees to report potential probs.
6. Develop procedures that allow the prompt, thorough investigation of alleged misconduct.
7. Initiate immediate and appropriate corrective action.
,8. Reduce the orgs exposure to civil damages and penalties, criminal sanctions, and
administrative remedies.
CIA - CORRECT ANSWERS✅✅Corporate Integrity Agreement
Reasons to Implement CRP - CORRECT ANSWERS✅✅1. demonstrates to community that
provider has a strong commitment to honesty and responsible corporate citizenship.
2. reinforce employees' innate sense of right and wrong.
3. Helps provider fulfill its legal duty to govt and private payors.
4. Cost effective in the long run.
5. More accurate view of employee and contractor behavior relating to fraud and abuse.
6. Enhanced quality of patient care.
7. Provides procedures to promptly correct misconduct.
8. Mitigate any sanctions imposed by the govt.
9. Voluntarily implementing is better than govt imposed any day!
10. May protect corporate directors from liability.
HIPAA - CORRECT ANSWERS✅✅Health Insurance Portability and Accountability Act of
1996 - criminal offense to submit false claims. Also states we will protect patient
information.
False Claims Act - CORRECT ANSWERS✅✅govt may investigate and bring civil action
against providers found submitting incorrect claims on purpose.
Whistle Blower - CORRECT ANSWERS✅✅Qui Tam
Federal Sentencing Guidelines - CORRECT ANSWERS✅✅guidance for assessing fines is
designed so that sanctions imposed upon orgs and their ages, will provide just punishment,
adequate deterrence and incentive for orgs to take action.
Culpability Score - CORRECT ANSWERS✅✅Calculation of fines that adds points for
aggravating factors and subtracts points for mitigating factors.
, Culpability Score Aggravating Factors - CORRECT ANSWERS✅✅1. upper level employee
has participated in, condoned or willfully ignorant of the offense.
2. violation is a repeat offense.
3. govt was hindered during investigation.
4. awareness of and tolerance of violation were pervasive.
Culpability Score Mitigating Factors - CORRECT ANSWERS✅✅1. org have an effective
CRP
2. org reported the violation promptly
3. org cooperated w/govt investigation
4. org accepted responsibility.
Seven Elements of CRP - CORRECT ANSWERS✅✅1. Written standards of conduct
2. Designated a chief compliance officer
3. effective education and training
4. audits/evaluation techniques to monitor compliance.
5. reporting process/procedures for complaints.
6. appropriate disciplinary mechanisms
7. investigation and remediation of systemic problems.
10 Obstacles of Effective Implementation - CORRECT ANSWERS✅✅1. commitment and
buy in
2. funding
3. too many hats to be worn by individual(s)
4. interpreting laws and regulations
5. lack of resources/ staff
6. lack of education and training
7. resistance to change
8. lack of/poor communication
9. fear of retaliation/retribution
