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The CCA Health Compliance Program

CCA Health 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 Rhode Island Executive Office of Health and Human Services (EOHHS), including Medicaid and the Office of Inspector General (OIG).

This Compliance Program applies to all lines of business at CCA Health. The CCA Health 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 Health 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 CCA Health Fraud, Waste, and Abuse Program

The mission of the CCA Health Fraud, Waste, and Abuse (FWA) Program is to assist in protecting the integrity of CCA Health and federal and state programs by working to prevent, identify, investigate, correct, and report suspected incidents of fraud, waste, and abuse.

The Fraud, Waste, and Abuse Program is an integral part of our Compliance Program. CCA Health must work collaboratively to combat fraud, waste, and abuse. Anyone conducting business with CCA Health is expected to report any suspected cases of fraud, waste, or abuse to CCA Health through one of the following reporting mechanisms without fear of retaliation or retribution for reports made in good faith:

Report to the CCA Compliance Team
[email protected]

Report to the CCA Health Compliance Hotline:

Fill out a compliance incident report:
Compliance Incident Report1

CCA Health is subject to several laws and regulations pertaining to FWA, including, but not limited to, the federal Anti-Kickback Statute, the federal False Claims Act, the Rhode Island False Claims Law, and federal and state whistleblower protections.

Using the Rhode Island False Claims law, the False Claims Division conducts civil investigations and prosecutions against companies and individuals who mislead or defraud state or municipal entities through the use of false or fraudulent claims, records, or statements. A whistleblower is a person who exposes any kind of information or activity that is deemed illegal, unethical, or not correct within an organization that is either private or public. Whistleblower laws protect those who report false or fraudulent activity against retaliation and are granted federal and state protection.

Compliance and Fraud, Waste, and Abuse Program Resources

The Code of Conduct is the fundamental statement of the CCA Health governing principles. The Code of Conduct communicates to the CCA Health workforce, providers, contractors, and FDRs that compliance and ethics are an integral part of CCA Health. All FDRs 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 the CCA Health Code of Conduct Fraud, Waste, and Abuse Program Resources.

CCA Code of Conduct

HPMS Memo: Additional Guidance Compliance Program Training Requirements

Medicare Parts C and D Fraud, Waste, and Abuse Training Instructions

Medicare Parts C and D General Compliance Training

Combating Medicare Parts C and D Fraud, Waste, and Abuse

Medicare Fraud and Abuse: Prevention, Detection, and Reporting Fact Sheet

Visit the Medicare Learning Network1 for all CMS-sponsored training for providers and FDRs.

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