The Connection OnlineSM

April 2011

April 2011

Enhanced Medicare compliance program

As a Medicare Advantage (MA) plan, Regence must comply with the Centers for Medicare & Medicaid Services (CMS) regulations and requirements. Many of these also apply to first tier, downstream and related entities, such as participating physicians, dentists, other health care and dental professionals, facilities, contractors and vendors.

We are currently enhancing our Medicare compliance program and increasing monitoring efforts to ensure all applicable requirements are met. If you are a contracted Regence MedAdvantage provider, we encourage you to fully review the requirements for MA providers located in the Medicare Advantage Plans section of our Administrative Manual and, if necessary, take action now to ensure that you are in compliance.

Key requirements include:

  • Complete Medicare compliance training
  • Adopt and comply with a conflict of interest policy
  • Adopt and comply with a code of business conduct
  • Complete Medicare fraud, waste and abuse training
  • Ask questions and report the following through our anonymous hotlines:
    • Potential and actual instances of Medicare fraud, waste and abuse
    • Potential and actual instances of non-compliance with Medicare requirements
  • Verify that individuals who work directly or indirectly on any Federal health care program do not appear in the:
    • List of Excluded Individuals/Entities as published by the Department of Health and Human Services Office of the Inspector General
    • List of Debarred Contractors as published on the Excluded Parties List System by the General Services Administration

Learn more about the requirements (PDF) and steps to take for complying with them.

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