We remain in compliance with all state and federal laws that regulate the healthcare industry. We are committed to maintaining the highest standards of excellence, professionalism, ethics and integrity in all aspects of our operations. Our priority is to provide the highest quality services to our members, employees, providers and business partners. Our commitment is to conduct our business ethically and in compliance with all applicable state and federal laws and regulations.
As part of our efforts to promote a culture of compliance, we have established this website and confidential line to provide you with the necessary tools to report real or potential matters of concern related to the Compliance, Fraud, Abuse, Waste, Security and Privacy Program.
If you are aware of a situation that could be a potential compliance violation but you’re not sure, we can help. Simply call our confidential line for guidance or report the situation through this website. We will evaluate your concern in accordance with our applicable policies and procedures.
With everyone’s collaboration and strong commitment, we will be able to continue to strengthen our culture of Accountability, Compliance and Trust.
These are matters that most often represent a specific violation of a law and/or regulation, whether federal, local or our Policies and Procedures. For example, a violation of our Compliance Program and/or any activity that could be considered fraud, waste and/or abuse.
These are matters that in most cases represent a specific violation of a law and/or regulation, whether federal or local. For example, a violation of our Compliance Program and/or the Code of Conduct.
These are matters that most often represent a specific violation of a law and/or regulation, whether federal, local or our Policies and Procedures. For example, improper disclosure of Protected Health Information (PHI).
These are matters related to a form of abuse that involves the inappropriate use of an elderly person’s funds, property or resources, or those of an adult with disabilities by another person. For example, the misuse of that person’s funds, or the transfer of money and/or property under pressure.
We strive to preserve the confidentiality of the reports it receives, including the identity of the person making the report, if requested. Individuals have the option to report compliance concerns anonymously via the direct hotline and web reporting line and can be confident their anonymity will be protected – except when (a) disclosure becomes necessary for a proper investigation and, even then, disclosure will be made only when necessary, or (b) when disclosure is legally required by court order or court subpoena. We conduct investigations of any actual, potential or suspected misconduct with the utmost discretion, taking care to protect the reputation and identity of those being investigated.
We prohibit retaliation and intimidation against anyone for participating in the Compliance Program in good faith and making good faith reports regarding concerns about actual or potential violations, including but not limited to violations of the Code, our Compliance Program, Policies and Procedures and/or any other applicable law or regulation. We will not take any adverse action against a person for filing a complaint, reporting, participating in, investigating or assisting in an investigation of an alleged violation. Any person who engages in retaliation, intimidation and/or harassment may be subject to disciplinary action in the case of employees, or other appropriate action in the case of contractors.