CHC (CCB) case studies
CHC · Put your knowledge to work in context.
The Certified in Healthcare Compliance (CHC) credential is a professional certification for people who build, run, or work inside compliance programs in healthcare organizations - hospitals, physician groups, payers, pharmacies, device and lab companies, and the vendors that serve them. It signals that the holder understands how a compliance program is designed and operated day to day, not just how to read a regulation. The CHC case studies are 5 cases and about 3,725 words.
1The Overlapping-Use Hotline Call
A 400-bed community hospital's compliance hotline receives an anonymous call: a nurse in the surgical unit says the same physician repeatedly schedules two operating rooms at once and bills both, but she is unsure whether this is a billing issue or just a scheduling quirk. The compliance officer logs the call, then learns the physician is the hospital's top surgical revenue producer ($3.2M annually) and sits on the board's quality committee.
750 words, about 4 min2The Training That Everyone Passed
A regional health plan's compliance team launches its annual fraud, waste, and abuse (FWA) and privacy training in October. Completion is tracked in the LMS.
706 words, about 4 min3The Coding Audit That Found Too Much
A 12-physician orthopedic practice conducts an internal coding audit of 60 randomly selected evaluation-and-management (E/M) encounters. The auditor, a certified coder, finds that 9 of 60 (15%) were upcoded - mostly level-4 visits documented at a level-3 support level.
734 words, about 4 min4The Risk Assessment Nobody Owned
A mid-sized physician organization completes its annual compliance risk assessment in Q1. The prior year's assessment ranked 'telehealth billing' as low risk and 'HIPAA privacy' as high risk.
761 words, about 4 min5The Physician Who Won't Stop Coding That Way
A hospital-owned multispecialty group employs a surgeon who consistently bills a high-level E/M service with every procedure, producing a denial rate of 34% on those claims versus a group average of 8%. The compliance department sends two education letters and offers a one-on-one coding session; the surgeon declines the session, says the coders 'don't understand my documentation,' and continues the pattern.
774 words, about 4 min