Compliance and Fraud, Waste, and Abuse Programs

The Commonwealth Care Alliance Compliance Program

CCA is committed to conducting its business operations in compliance with ethical standards, internal policies and procedures, contractual obligations, and all applicable federal and state statutes, regulations, and rules, including but not limited to those pertaining to the Centers for Medicare & Medicaid Services (CMS) Part C and D programs and the Massachusetts Executive Office of Health and Human Services (EOHHS), including MassHealth and the Office of Inspector General (OIG).

This Compliance Program applies to all lines of business at CCA. CCA’s compliance commitment includes its internal business operations, as well as its oversight and monitoring responsibilities related to its First Tier, Downstream, and Related Entities (FDR).

CCA has formalized its compliance activities through a comprehensive Compliance Program. The Compliance Program incorporates the fundamental elements of an effective compliance program identified by CFR 422.503(b) (4) (vi) and CFR 423.504(b) (4) (vi) and the OIG Federal Sentencing Guidelines. 

The Commonwealth Care Alliance Fraud, Waste, and Abuse Program

The mission of the CCA Fraud, Waste, and Abuse (FWA) Program is to help protect the integrity of CCA and federal and state programs by preventing, identifying, investigating, correcting, and reporting suspected incidents of fraud, waste, and abuse.

If you suspect fraud, waste, or abuse, please report it using one of the options below. Reports made in good faith may be submitted without fear of retaliation or retribution.

• Call: Fraud Hotline 1-844-415-1272 (follow the prompts for reporting Fraud)
• Online: Fraud, Waste & Abuse and Ethics Reporting Portal¹
• Mail: Send a written letter to:

CareSource
Attn: Program Integrity
P.O. Box 1940
Dayton, OH 45401-1940

Additional Reporting Options (not anonymous):

• Email: [email protected]
• Fax: 1-800-418-0248

You may choose the reporting option that works best for you. CCA is subject to several laws and regulations related to fraud, waste, and abuse, including the federal Anti-Kickback Statute, the federal False Claims Act, the Massachusetts False Claims Law, and federal and state whistleblower protections.

Using the Massachusetts False Claims law, the False Claims Division investigates and pursues civil cases against companies and individuals that mislead or defraud state or municipal entities through false or fraudulent claims, records, or statements. Federal and state whistleblower laws protect individuals who report suspected false or fraudulent activity from retaliation.

• The Whistleblower Protection Program¹

Office of the Inspector General Resources

The Office of the Inspector General (OIG)¹ offers free educational materials¹ to help physicians understand federal laws that protect Medicaid and Medicare programs and beneficiaries from fraud, waste, and abuse.