CHC Cheat Sheet 2026

The 30 highest-yield CHC facts, distilled from real exam questions. Print it, save it as a PDF, or study it here — free, no sign-up.

1. Under an effective compliance program, who typically bears primary oversight responsibility for the compliance hotline? → The Chief Compliance Officer
2. Which of the OIG's seven elements of an effective compliance program specifically addresses reporting mechanisms? → Element 4: Open lines of communication
3. The 'two-midnight rule' in Medicare billing primarily governs which type of admission? → Inpatient hospital admissions and whether they meet criteria for Part A payment
4. What is the statute of limitations for the government to bring a False Claims Act civil suit not involving a qui tam relator? → 6 years
5. Which agency operates the primary federal hotline (1-800-HHS-TIPS) for reporting Medicare and Medicaid fraud? → Office of Inspector General (OIG)
6. What is a Recovery Audit Contractor (RAC) and what is its role in billing compliance? → A CMS-contracted auditor that identifies and recovers improper Medicare payments
7. What is the primary purpose of developing a Corrective Action Plan (CAP) after an internal investigation substantiates a compliance deficiency? → To identify and remedy the root cause of the non-compliance to prevent its recurrence.
8. What is the purpose of a 'charge master' (chargemaster) in hospital billing compliance? → A comprehensive list of all billable services, supplies, and fees used to generate claims
9. What does 'clawback' mean in the context of healthcare billing compliance? → The recovery by a payer of previously paid funds determined to be improper or overpaid
10. Which federal statute prohibits submitting claims for services that were not actually rendered to Medicare or Medicaid? → False Claims Act
11. Which coding system is primarily used for inpatient hospital diagnoses and procedures for Medicare billing under the MS-DRG system? → ICD-10-CM/PCS (International Classification of Diseases)
12. She implies that when hospital administrators said that most mistakes happen at the "sharp end," they meant that... → They occur during the interactions between caregivers and patients
13. What stage of the Medicare Part A or Part B appeals procedure does a qualified independent contractor review the appeal? → Second level of appeal
14. A Corporate Integrity Agreement (CIA) is typically entered into between a healthcare entity and which agency? → OIG
15. Which of the following best reflects the Federal Sentencing Guidelines' approach to punishment? → Case-specific
16. Which of the following methods is MOST effective for evaluating the long-term impact of compliance training on actual employee behavior? → Reviewing the findings from ongoing auditing and monitoring activities.
17. Under which laws are healthcare employees protected from retaliation for reporting fraud or patient safety concerns to federal authorities? → False Claims Act and ACA Section 1558
18. Which of the following best describes the 'knowing' standard under the civil False Claims Act (FCA)? → The individual acted with deliberate ignorance or reckless disregard of the truth.
19. Which federal agency publishes the OIG Work Plan that healthcare compliance officers use to prioritize audit areas each year? → Office of Inspector General (OIG)
20. A key distinction between the Stark Law and the Anti-Kickback Statute (AKS) is that the Stark Law: → applies only to referrals made by physicians for designated health services (DHS).
21. A compliance officer discovers that a vendor is on the SAM.gov exclusion list. What is the appropriate immediate action? → Terminate or suspend the vendor relationship immediately to avoid program liability
22. Which of the aforementioned organizations has access to the Healthcare Integrity and Protection Data Bank? → State agencies
23. What is 'upcoding' in the context of healthcare billing compliance? → Billing for a service with a higher-value code than the service actually performed
24. When a patient at risk is left unattended and experiences a negative drug reaction, this is referred to as ad (n)... → Sentinel event
25. Which organization publishes the National Correct Coding Initiative (NCCI) edits used to prevent improper Medicare billing? → CMS
26. What remedies does the False Claims Act provide to a whistleblower who was wrongfully terminated for protected reporting activity? → Reinstatement, double back pay, and attorneys' fees
27. Whom do you need to notify of the "initial COBRA"? → Covered Employees and Covered Spouse
28. According to research, the majority of unfavorable incidents linked to negligence happen in the... → Emergency room
29. In medical documentation for billing, what does the principle of 'if it wasn't documented, it wasn't done' mean for compliance? → Services billed must be supported by clinical documentation in the medical record
30. Which type of audit involves reviewing claims BEFORE they are submitted to payers to catch errors proactively? → Prospective audit