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2025 - 2026 CPCO MOCK EXAM
|120+Qs&As|100%VERIFIED|A+GRADE
A History of Healthcare Compliance in the U.S. Question 1 Dr. X hires a nurse without looking to see if she was on the OIG’s Exclusion List. The nurse was previously convicted of committing fraud and was excluded. Dr. X receives payments from Medicare for services rendered to Medicare beneficiaries. Is it ok for Dr. X to have this nurse on staff? Yes, as long as the nurse pays a CMP. No, Dr. X will receive a CMP for hiring an excluded individual. Yes, as long as the nurse only assist with Medicare patients. No, the nurse may not work for anyone who sees Medicare Beneficiaries ever again. Question 2 Which statement is correct when a provider is excluded from participation with Medicare, Medicaid, and other Federal healthcare programs? The provider cannot work with, and are prohibited from participation in, all programs that deal with state or federal dollars. Excluded from Federal healthcare programs only if the provider does not have a compliance program in place. Provider is excluded when not attending training and certify to the OIG. Excluded if the provider does not allow an independent review organization to conduct annual reviews. Question 3 CPUP was the first large fraud case that involved a teaching hospital where Residents and Fellows worked. Where is CPUP located? Michigan Boston New York Pennsylvania
Question 4 Which component of the OIG operates the OIG Hotline? Office of Counsel to the Inspector General Office of Management & Policy Office of Evaluations & Inspections Office of Investigations Question 5 What is the OIG’s Five-principle Strategy made up of? Enrollment, Payment, Compliance, Oversight and Response Enrollment, Fines, Compliance, Oversight and Response Enrollment, Payment, Compliance, Audits and Response Enrollment Payment, Compliance, Oversight and Audits Question 6 In 1992, the General Accounting Office (GAO) identified Medicare claims to be at high risk for fraud and abuse(GAO/ HR- 93 - 6, Dec. 1992). Subsequent to this determination, in 1996, what was initiated? An audit of HCFA (CMS) Medicare claims payment system. OIG compliance program documents for each provider type. The creation of evaluation and management documentation guidelines. The creation of corporate integrity agreements. Question 7 In February 1998, the OIG created the first compliance guidance document. What type of provider was the first compliance program guidance issued for?
Office of Inspector General (OIG) Office for Civil Rights (OCR) Department of Health & Human Services (HHS) Department of Justice (DOJ) Question 11 Kathy, the Compliance Officer at a small provider office, is notified that a patient with limited english proficiency (LEP) is on the schedule and will need an interpreter. According to the LEP requirements, an interpreter should be provided: for a small fee to the patient. for a small fee to the insurance carrier. at no cost to the patient. An interpreter is not required. Question 12 Which is not considered one of the OIG’s “Five Principles” to combat healthcare fraud, waste, and abuse? Compliance Insurance Payment Enrollment Question 13 The OIG has developed a five-principle strategy to combat healthcare fraud, waste, and abuse. Which of these options is NOT included in these principles? Establish payment methodologies that are reasonable and responsive to changes in the marketplace.
Scrutinize individuals and entities that are participating as providers and suppliers after their enrollment in healthcare programs. Assist healthcare providers and suppliers in adopting practices that promote compliance with program requirements, including quality and safety standards. Vigilantly monitor programs for evidence of fraud, waste, and abuse. Question 14 USSC is important as it related to the Federal Sentencing Guidelines and is thus related to the core elements of compliance. What does the USSC acronym stand for? United States Security Commission United States Sentencing Commission United States Sentencing Committee United States Security Committee Question 15 Which HHS Title is the Limited English Proficient Persons (LEP) requirement covered under? V VI VII II Question 16 Which office performs independent audits of HHS programs and/or HHS grantees and contractors to examine their performance? Immediate Office of Inspector General Office of Audit Services
customer loyalty, community support, and financial success. Question 20 The OIG has developed five principles as part of their strategy to promote integrity in the healthcare industry. Which of these statements are included in these principles? Vigilantly monitor programs for evidence of fraud, waste, and abuse. Establish compliance officers for each healthcare provider’s office. Scrutinize compliance plans to ensure all compliance plans are uniform and unaltered. Respond swiftly to natural catastrophies. Question 21 Which statement is TRUE regarding a corporate compliance plan? Compliance plans need to be tailored to fit the unique needs of every organization or physician practice. Everyone has to follow the same rules and have the same policies & procedures in place. Compliance plans just have a minimum cost to meet so the smaller practices can participate. The government wants to ensure that everyone budgets for compliance plans and has the same regulations and protocols. Question 22 Which of the following is NOT one of the 7 Elements of an Effective Compliance Program? Conducting appropriate training and education Responding appropriately to detect offenses and developing and implementing corrective action Developing open lines of communication Enforcing disciplinary standards through well publicized guidelines
Question 23 What is considered a significant element in committing an act of fraud? Billing for services performed Reviewing OIG Exclusions Using the Compliance Guidance as a guide for your practice Knowingly and Intent Question 24 The Department of Labor requires compliance with employee and employer laws including: FLSA, OSHA, CRA, and ERISA ADA, OCR, HHS, and HIPAA HIPAA, OCR, CRA, and FLSA OSHA, ADA, HIPAA, and ERISA Question 25 The Department of Labor (DOL) requires compliance with employee and employer laws. Which ACT is NOT overseen by the Department of Labor? Fair Labor Standards Act(FLSA) Employee Retirement and Income Safety Act (ERISA) Clinical Laboratory Improvement Amendments (CLIA)Occupational Safety and Health Act(OSHA)
Document the time and date of all training. Who attended is not required. Question 4 Tom creates a compliance program training for his staff. The training includes the operation and importance of the compliance program and the consequences of violating the standards and procedures set forth in the program. Which of the following should also be included in the training? The job description for each employee in the organization. An organizational chart for the employees in the organization. The role of each department manager in the operation of the training program. The role of each employee in the operation of the training program. Question 5 Which regulation is violated when a physician is part owner of a hospital or imaging center and refers patients to that facility/center, unless specific OIG guidelines are followed? Anti-Kickback Statute The Patient and Protection and Affordable Care Act Physician Self-Referral Act Corporate Integrity Agreement Question 6 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? No additional steps are necessary; the requirement to train new employees has been met. Perform a baseline assessment of the employee’s competency scores to determine if additional training is required. Retain the training record for employee evaluation reviews. Repeat the training in 1 year. Question 7
When the term “Open Door Policy” is used in reference to effective communication, what is this referring to? The Compliance Office must always leave his/her door open. Only the physicians can have access to the Compliance Officer. The Compliance Officer is accessible to all employees via many methods of communication. The Compliance Officer will only be able to effectively communicate in the office with the door open. Question 8 How often should the Tim, Compliance Officer for XYZ Community Hospital, update the Compliance Program/Compliance Plan? As laws and regulations change and at least annually Annually regardless of changes Twice per year When the providers determine it needs revision Question 9 John is the new Compliance Officer for a small community medical practice of 10 providers. He wants to design a great compliance plan for the group. What does the OIG consider the most important aspect of a Compliance Program? The compliance officer. The policy library. Implementation of the Compliance Program. Review dates for the Compliance Program. Question 10 ABC Provider Group and Apple Medical Group agree to pool their resources for the purpose of accomplishing a specific task. What is this called?
Determine who does not need training to save on cost; determine type of training; and determine when and how often the training/education should occur. Determine who needs training; determine type of training; and determine the least amount of time the training can be done to save on resources. He should not worry about it because all training needs to be unique. Question 14 Tom is the billing manager of a large provider group. Tom reports a significant increase of correspondence from the carriers and insurers challenging the medical necessity or validity of claims. What is the next step the Compliance Officer should take regarding the reported incident? Start an investigation. Add a new policy and procedure for claims submission. Assign everyone training for diagnostic coding. Stop all claim submissions. Question 15 What is it considered when an employee, provider, or anyone that deals with Federal or State healthcare dollars, has intent to receive payment for services not legitimately rendered? an error fraud a mistake a kickback Question 16 ABC Medical office does not have professional coders on staff but has hired Amy to provide coding and billing compliance training for the staff. According to the OIG compliance guidance, when professionalcoding staff is not employed, who should be trained? All managers in the practice. All employees in the practice. Any individual directly involved with billing and coding.
Only certified billers and coders should be trained. Question 17 Everyone should be educated regarding their role in adhering to the Compliance Program including their duty to report. employees who are chronically late suspected misconduct safety issues quality issues Question 18 Kim, the Compliance Officer for ABC Provider Group, created a compliance plan and policy one 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. Which statement is TRUE regarding this scenario? The non-compliance should be noted in the new plan and the group should try to be better about compliance the following year. The non-compliance has 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 No issues of no-compliance have exist in the scenario. The non-compliance has created issues that will cause huge fines for the practice Question 19 A physician practice is concerned with being flagged for audits. To avoid being flagged for an audit, the providers decide to report all office visits as a level 3. As the compliance officer for the practice, you inform the office manager that this is a compliance risk. What policy and procedure would you cite that could trigger an investigation or audit? Clustering Billing for items or services not performed
Question 23 Failure to respond quickly to suspected or alleged instances of non-compliance threatens the organization’s reputation as trustworthy, law-abiding, and. the organization’s ability to accept cash patients the organization’s ability to participate with federally funded healthcare plans and/or third party payers the organization’s ability to hire new employees the organization’s ability to scrutinize practices for other providers Question 24 The first responsibility of the Compliance Officer is the development of the Compliance Program. What is the first step in the process that needs to be completed before the formal Compliance Program documents are drafted? Policies and procedures should be developed. Training and education should be conducted. Areas of risk need to be assessed. Conduct a HIPAA and OSHA audit. Question 25 Why should hotline allegations be tracked? To find out who is making the call. To look for groups of employees who complain. To establish patterns or trends of non-compliance. To identify 100% of false claims. Question 1
Other Applicable OIG Compliance Program Guidance
Joan is the Compliance Officer for ABC Provider Group. One of her providers asked her which Federal agency provides compliance program guidance to providers and covered entities? Which agency should Joan answer with? Office of Inspector General Immediate Office of the Inspector General Office on Auditing Centers for Medicare & Medicaid Services Question 2 Jackie is a coder and biller for ABC Provider Group. She often puts modifiers on various CPT® codes so that they can get paid, regardless of the documentation. What is this an example of? Misuse of modifiers Billing to the best of your ability A Kick Back Scheme Professional Courtesy Question 3 Which, of the following, is NOT a purpose of the Requisition Lab slip? Capture the correct program information Ensure the physician or other authorized individual has made an independent medical necessity decision with regard to each test the organization will bill Encourage physicians or other authorized individuals to submit the diagnosis information for all tests ordered Contain a statement that indicates Medicare generally covers all routine screening tests Question 4 Third party billing companies should have policies and procedures for addressing risk areas resulting from internal audits according to the OIG. Which risk area does this include?
No, the tests must be reasonable and necessary to diagnose or treat a patient’s medical condition. Yes, as long as the tests are ordered by a provider with an NPI. Question 8 Which factor is NOT considered in the OIG Work Plan? Mandatory requirements for OIG reviews, as set forth in laws, regulations, or other directives. Requests made or concerns raised by Congress, HHS management, or the Office of Management and Budget. Top management and performance challenges facing HHS. Inconvenience to the healthcare industry. Question 9 Which, of the following, is NOT a key risk area identified for third-party medical billing companies by the OIG Compliance Program Guidance? Unbundling Upcoding Provider’s signature lacking Inappropriate balance billing Question 10 What third-party is in a unique position to discover fraud? Competing providers Patients Medical Billing Companies
Anyone who is involved in the medical industry Question 11 Laura is the Compliance Officer for Angel Nursing home. She is training the staff on tracking patient outcomes. Why it is important for nursing facilities to track patient outcomes? To determine whether or not they will get reimbursed. To see if the patient’s family will refer them to other potential clients. To determine which employee is working hardest for the patients. To accomplish compliance. Question 12 When a compliance program is established, what does the OIG recommend a billing company do regarding the company’s operations. Take a snapshot from a compliance perspective. Demand corrective action Audit the financials Complete a staff report on each employee Question 13 Which office listed below is NOT addressed in the OlG Work Plan? Office of Audit Services Office of Evaluation and Inspections Office of Investigations Office of Health and Human Services
