Fraud, Waste & Abuse/Compliance Resources

Health Insurance Portability and Accountability Act of 1996 (HIPAA)

The Health Insurance Portability and Accountability Act of 1996 called for many changes in health care. April 14, 2003 finalized federal regulations called HIPAA Privacy Regulations became effective. These regulations require that we take extra precautions to protect personal health information known as PHI. Care1st has taken the necessary precautions to protect PHI and has developed policies and provided training on the issue to assist our staff.

HIPAA also involves Transaction Code Sets referred to as TCS provisions. These provisions require that health plans and health care payors follow requirements established by the federal government regarding health care billing and reimbursement. Soon you’ll be hearing more about HIPAA security. We’ll keep you informed of our HIPAA efforts through our Network Newsletter. If you have questions or concerns about HIPAA in your office visit the Department of Health Services, Office of Civil Rights website at www.hhs.gov/ocr/hipaa.html or the CMS website at www.cms.hhs.gov/hipaa/hipaa2/. Additionally, a HIPAA hotline has been established by CMS to help answer HIPAA administrative simplification questions 1-866-282-0659.

If you have further questions about HIPAA, please contact Care1st at (602) 778-8318 or call the Care1st Compliance Hotline at 1-877-837-6057 or Click here to visit the HIPAA website

Resources

Deficit Reduction Act (DRA)
AHCCCS requires Care1st to train our provider network and their staff on the following aspects of the Federal False Claims Act provisions:

• The False Claims Act, Including Examples of False Claims and Remedies
• Federal Whistleblower Protections
• AHCCCS - Prohibited Acts and Remedies

For training materials, please visit the AHCCCS website (training link is located on the left side of the page): http://www.ahcccs.state.az.us/DRA/Default.aspx 

Fraud, Waste and Abuse
CMS and AHCCCS require all health plans to provide compliance training, including fraud, waste and abuse training, to first-tier, downstream, and related entities (contracted provider network, etc.).

Please use the information contained in the links below to provide training and information to your team on fraud, waste and abuse. Care1st and ONECare appreciate your assistance with disseminating and providing this information to your employees. If you need additional information or would like assistance in completing training, please contact our Provider Network Operations Team at 602-778-1800 (Options 5, 7).

• Fraud, Waste and Abuse Training Tool
• Fraud Awareness for Providers

CMS Website
Answers to Frequently Asked Questions, links to other HIPAA sites, and information on the law, regulations, and enforcement are located here. Go to their website!

FREE CMS Fax Back Service
Do you need information on HIPAA but don't have Internet access? CMS offers fax back service to businesses without Internet access. Many documents are available by calling 1-800-874-5894. Be sure to have your fax number ready when you call.

CMS E-mail Box
Send HIPAA administrative simplification questions here!

CMS HIPAA Hotline
1-866-282-0659, the hotline is to help answer HIPAA administrative simplification questions.

HHS' Office for Civil Rights (Privacy)
The US Department of Health and Human Services (HHS) Office oversees the privacy requirements.