Commonwealth Care Alliance

Commonwealth Care Alliance

Providers > Compliance and Fraud, Waste and Abuse Program Resources

Compliance and Fraud, Waste and Abuse Program Resources

Commonwealth Care Alliance’s commitment to compliance includes requiring its contracted entities and their subcontractors to comply with applicable federal and state regulations.  Commonwealth Care Alliance is committed to preventing, detecting, identifying, and reporting suspected cases of fraud, waste, and abuse. We look to our providers, First Tier, Downstream and Related Entities (FDRs), and contractors to assist us in this endeavor.

FDRs are required to complete general compliance and fraud, waste, and abuse training. However, if your organization is enrolled in the Medicare Part A or B program, you have already satisfied the fraud, waste, and abuse training and education requirement.

The Centers for Medicare and Medicaid Services (CMS) has developed a training program, consisting of two components, “Combating Medicare Parts C and D Fraud, Waste, and Abuse Web-Based Training Course” and “Medicare Parts C and D General Compliance Training.” Links to these trainings can be found below. We ask that all of your employees and contractors who provide services to Commonwealth Care Alliance and/or our members take this training within 90 days of hire/contract  and on an annual basis.

There is a “Certificate of Completion” at the end of the training through CMS  MLN Provider Compliance web based training. Please have each employee complete this required training and maintain a copy of the certificate for ten years. Commonwealth Care Alliance reserves the right to request verification that your employees and contractors have completed this training.

Commonwealth Care Alliance policies and procedures are available upon request. If you have any questions regarding this training, fraud, waste or abuse, would like access to a policy and procedure, or have any other compliance-related questions, please contact Commonwealth Care Alliance’s Department of Regulatory Affairs and Compliance at (617) 426-0600 or via  email. Please note: any confidential or anonymous concerns should be reported to Commonwealth Care Alliance via the 24-hour Compliance Hotline 1-800-826-6762.

The Code of Conduct is the fundamental statement of the CCA’s governing principles.  The Code of Conduct communicates to CCA’s Workforce, providers, contractors and FDR’s that compliance and ethics are an integral part of CCA.  All FDR’s must also distribute a Code of Conduct (Standards of Conduct) to their employees and downstream entities at time of hire/contract and annually thereafter.  If an FDR does not have their own Code of Conduct, they may adopt CCA’s Code of Conduct (link below).

Fraud, Waste & Abuse Program Resources

Download Combating Medicare Parts C and D Fraud, Waste, and Abuse (pdf)
Download Medicare Parts C and D General Compliance Training (pdf)
Download Commonwealth Care Alliance Fraud, Waste and Abuse Program Description (pdf)
Download Medicare Fraud and Abuse Preventing Detection and Reporting Fact Sheet* (pdf)
Download HPMS  Memo: Reducing the Burden of the Compliance Program Training Requirements June 17, 2015 (pdf)
Download HPMS Memo: Additional Guidance Compliance Program Training Requirements February 10, 2016 (pdf)
Download Medicare Parts C and D Fraud, Waste and Abuse Training Instructions (pdf)

Visit the Medicare Learning Network* for all CMS sponsored training for Providers and FDRs

Code of Conduct:

Download Commonwealth Care Alliance Code of Conduct (pdf)

 

*When you click this link, you will leave Commonwealth Care Alliance’s web site.

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Last Updated 12/04/2015