CCT - Certified Compliance Technician Compliance Oversight Agencies Questions and Answers

Question 1

A hospital's compliance department uncovers a sophisticated, multi-state scheme involving several physicians and a third-party billing company to systematically submit false claims to Medicare.
The scheme appears to be criminal in nature.
In addition to the HHS-OIG, which federal agency would have primary jurisdiction to prosecute this criminal healthcare fraud?

Accepted Answer

Department of Justice (DOJ)

Answer

Centers for Medicare & Medicaid Services (CMS)

Answer

The Joint Commission (TJC)

Answer

Office for Civil Rights (OCR)

Question 2

Which agency within the Department of Health and Human Services (HHS) is primarily responsible for investigating fraud, waste, and abuse in HHS programs and for issuing both permissive and mandatory exclusions from federal healthcare program participation?

Accepted Answer

Office of Inspector General (OIG)

Answer

Food and Drug Administration (FDA)

Answer

Centers for Disease Control and Prevention (CDC)

Answer

Centers for Medicare & Medicaid Services (CMS)

Question 3

A provider has a question about whether a proposed business arrangement might violate the Anti-Kickback Statute. To seek formal guidance and potential protection from prosecution for that specific arrangement, the provider can request an Advisory Opinion from which agency?

Accepted Answer

Office of Inspector General (OIG)

Answer

Centers for Medicare & Medicaid Services (CMS)

Answer

Department of Justice (DOJ)

Answer

State Medical Board

Question 4

A patient files a complaint alleging that a hospital clinic improperly shared their health information with a third-party marketer without authorization. Which federal agency is primarily responsible for investigating and enforcing patient rights under the HIPAA Privacy Rule?

Accepted Answer

Office for Civil Rights (OCR)

Answer

The Joint Commission (TJC)

Answer

Office of the National Coordinator for Health Information Technology (ONC)

Answer

Federal Bureau of Investigation (FBI)

Question 5

While the Office of Inspector General (OIG) focuses on fraud and abuse enforcement, which agency is primarily responsible for establishing the rules and regulations for participation in, and payment by, the Medicare and Medicaid programs?

Accepted Answer

Centers for Medicare & Medicaid Services (CMS)

Answer

Department of Justice (DOJ)

Answer

State Medicaid Agencies

Answer

Office for Civil Rights (OCR)

Question 6

A state's attorney general's office receives a whistleblower tip about a large network of dentists systematically billing the state's Medicaid program for services that were never rendered. Which specialized state-level unit would be responsible for investigating and prosecuting this type of fraud?

Accepted Answer

Medicaid Fraud Control Unit (MFCU)

Answer

State Department of Health

Answer

Regional Office of Inspector General (OIG)

Answer

State Licensing Board for Dentistry