CHC (AHE) 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 health care organizations - hospitals, physician groups, health plans, pharmacies, device and life-science companies, and the vendors that serve them. It signals that the holder understands how a compliance program is structured and how it operates day to day, not just that they can recite regulations. The CHC case studies are 5 cases and about 2,430 words.
1The Bonus That Followed the Referrals
A 40-provider orthopedic group pays its six highest-revenue physicians a quarterly 'productivity bonus.' The formula is 30% of the group's net collections on imaging and physical therapy services ordered by that physician during the quarter, regardless of who performed or supervised the service. The group owns its MRI and PT suite.
564 words, about 3 min2The Training Module Everyone Clicked Through
A 900-employee home health agency rolled out a new 20-minute online HIPAA module. Completion rate is 99.2%.
452 words, about 2 min3The Hotline Report About the Billing Manager
An anonymous hotline report alleges that a billing manager 'upcodes' visits to the highest-level E/M code when physicians leave documentation thin, and that she 'has been doing it for years and everyone knows.' The compliance officer pulls a sample: the manager's own accounts show 71% level-5 E/M codes versus a peer average of 22%. The manager is well-liked, has 19 years of tenure, and is the only person who knows the legacy billing system.
475 words, about 2 min4The Risk Assessment That Skipped the New Service Line
A regional health system completed its annual compliance risk assessment in March. In June it launched a new telehealth prescribing service for controlled substances across three states, staffed by contracted NPs, with a new e-prescribing vendor.
459 words, about 2 min5The Overpayment Clock Nobody Watched
During a routine internal audit in February, a hospital's compliance team identifies that a coding error caused $480,000 in overpayments on Medicare claims over the prior 18 months. The error was caused by a software configuration mistake that mapped a nonsurgical code to a surgical DRG.
480 words, about 2 min