Corporate Compliance

Compliance Department

Care1st Health Plan is committed to ethical and legal business practices to advance its health care mission.

Care1st is also dedicated to the continued establishment and maintenance of an effective Medicare compliance program, conforming to standards defined in the Federal Sentencing Commission Guidelines Manual and Compliance Program Guidance Documents issued by the Office of Inspector General (OIG) of the United States Department of Health and Human Services (DHHS) and the Centers for Medicare & Medicaid Services (CMS).

E-Compliance NewslettersMember Newsletters
Coming Soon Compliance Member Newsletter 2014 - Spanish
Coming Soon Compliance Member Newsletter 2014 - English
 

Board of Directors Compliance Spotlight

Compliance Bulletins

FDR HIPAA Training Materials, Attestation, and DHCS PIR Form

Attestation Form for First-Tier, Downstream, and Other Related Entities (FDRs)

Distribution of Standards of Conduct For Vendors and FDRs

In accordance with CMS Compliance Guidance, Care1st requires that Anti-Fraud Plan (AFP) and Policies and Procedures be distributed to Vendor and FDR employees. These documents are provided in the section Care1st Standards of Conduct, Anti-Fraud Plan, and Policies & Procedures Documents, below. Please distribute these to your employees, and ask them to complete and return the FDR Attestation document to:

  • ComplianceDepartment@care1st.com or fax to (323) 889-2104, Attention: Michael Osorio, Chief Compliance Officer. Please call (323) 889-6638, ext. 5202, for any questions you may have.

If you suspect compliance, ethics, or integrity violation, or have questions about specific practices, please use the following resources:

  • Call Care1st’s Compliance HOTLINE at 1-877-837-6057 anonymously. Available 24/7. Toll-Free
  • Contact the Compliance Department at ComplianceDepartment@care1st.com
  • Contact the Care1st’s Corporate Compliance Office at extension 6202

Care1st Standards of Conduct, Anti-Fraud Plan, and Policies & Procedures Documents:

Doing the Right Thing First

The Care1st Corporate Compliance Department is responsible for the organization's compliance and ethical conduct in all matters.

Our Responsibilities

  • Proactive prevention of fraud and abuse and other illegal activities through education and training of healthcare employees, providers and members.
  • The Corporate Compliance Department is also instrumental in the enforcement of policies and procedures, and in generating an environment where the prevailing goal is "to always do the right thing and to do it the right way."

Compliance Hotline: 1-877-837-6057

If you suspect compliance, ethics or integrity violation, or have questions about specific practices, call or write to Care1st’s Compliance Office: (323) 889 – 6638, ext. 6202; ComplianceDepartment@care1st.com.

Deter, Detect, Defend, Report

Medical identity theft occurs when someone steals your personal information (like your name, Social Security number, or Medicare number) to obtain medical care, buy drugs, or submit fake billings to Medicare in your name.

Medical identity theft can disrupt your life, damage your credit rating, and waste taxpayer dollars. The damage can be life-threatening to you if the wrong information ends up in your personal medical records.

Deter - Protect Your Personal Information

  • Guard your Medicare and Social Security numbers. Treat them like you would treat your credit cards.
  • If it's free, they don't need your number! Be suspicious of anyone who offers you free medical equipment or services and then requests your Medicare number.
  • It's illegal, and it's not worth it! Do not let anyone borrow or pay to use your Medicare ID card or your identity.

Detect - Watch Out for These Common Fraud Schemes

  • Just walk away if people approach you in parking lots, shopping centers, or other public areas and offer free services, groceries, transportation, or other items in exchange for your Medicare number.
  • Simply hang up the phone if someone calls you claiming to be conducting a health survey and asks for Medicare number.
  • Don't give your information to telephone marketers who claim to be from Medicare or Social Security and asks for payment over the phone or Internet. They may want to steal your money.

Defend - Check Your Medical Bills, Medicare Summary Notices, Explanations of Benefits and Credit Reports

  • Were you charged for any medical services or equipment that you didn't get?
  • Do the dates of services and charges look unfamiliar?
  • Were you billed for the same thing twice?
  • Does your credit report show any unpaid bills for medical services or equipment you didn't receive?
  • Have you received any collection notices for medical services or equipment you didn't receive?

Report - Report Medicare Fraud and Medical Identity Theft

  • If you spot unusual or questionable charges, contact your health care provider. It may just be a mistake.
  • If your complaint is not resolved by your provider, report the questionable charges to Medicare.
  • If you suspect Medicare fraud, contact the Department of Health & Human Services Office of Inspector General.
  • If you think someone is misusing your personal information, contact the Federal Trade Commission.

Fraud, Waste, and Abuse & General Compliance Training Materials

The Centers for Medicare & Medicaid Services (CMS) require plan Sponsors to provide Fraud, Waste, and Abuse (FWA) & General Compliance Training to health plans’ contracted first-tier, downstream, and related entities (FDRs), as well as to FDRs employees who are involved in the administration or delivery of Parts C and D benefits.

Additional Training Materials

Contact Other Resources

Department of Health & Human Services Office of Inspector General Hotline

Report suspected Medicare fraud
Phone: 1-800-447-8477 (1-800-HHS-TIPS)
TTY: 1-800-377-4950 | FAX: 1-800-223-8164
E-mail: HHSTips@oig.hhs.gov
Online: OIG.HHS.gov/fraud/hotline

Medicare Call Center and SMPs

Report questionable charges to Medicare
Phone: 1-800-633-4227 (1-800-MEDICARE)
TTY: 1-877-486-2048 | Online: medicare.gov

You can also contact your local Senior Medicare Patrol (SMP) worker, who work locally to empower seniors to fight health care fraud and resolve errors. To find an SMP in your area, go to www.smpresource.org or call 1-877-808-2468

  • If your Medicare card is lost or stolen, report it right away:
    Call Social Security at 1-800-772-1213 (TTY: 1-800-325-0778) for a replacement.
  • Get help reading your Medicare Summary Notice at: www.medicare.gov/basics/SummaryNotice
    Get a free credit report each year by calling 1-877-322-8228

Federal Trade Commission's Identity Theft Hotline

Report misuse of your personal information: Phone: 1-877-438-4338 (TTY: 1-866-653-4261)
On the Web at: www.FTC.gov/idtheft

To learn more about medical identity theft, visit: www.WorldPrivacyForum.org/medicalidentitytheft

The California Department of Health Care Services

The Department of Health Care Services asks that anyone who observes or has knowledge of suspicious health care activity to call the DHCS Medi-Cal Fraud Hotline telephone number, 1-800-822-6222, to report it. Visit the website: Stop Medi-Cal Fraud

Privacy Notices — How Medical Information About You May Be Used

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