Compliance Program Requirement

The Centers for Medicare & Medicaid Services (CMS) mandates that CarePlus and all CarePlus-contracted entities supporting a Medicare contract adhere to CMS-outlined compliance program requirements upon initial contract and as necessary thereafter.

The following documents and information are provided to help healthcare providers, third parties, and those supporting them understand the training requirements.

  • FAQs

    Documents referenced in this guidance material and via any separate CarePlus mail notification(s) also are available on this page. Should your organization require a copy of any of the documents, you can review, download, and print them from this webpage.

    FAQs about Compliance Program Requirements

  • Compliance Policy for Contracted Healthcare Providers and Third Parties

    This policy communicates CarePlus’ and our parent company, Humana’s, strong and explicit organizational commitment to conducting business ethically, with integrity and in compliance with applicable laws, regulations, and requirements. CarePlus requires contracted healthcare providers and third parties to uphold a similar commitment to ethical conduct and ensure that they, their employees, and downstream entities who support CarePlus comply with the guiding principles outlined within this policy.

    Compliance Policy for Contracted Healthcare Providers and Third Parties

  • Ethics Every Day (Standards of Conduct)

    Here we have posted our “Ethics Every Day for Contracted Healthcare Providers and Third Parties,” which is closely aligned with CarePlus’ and Humana’s – our parent company – standards of conduct for employees. We invite contracted healthcare providers and third parties to review this information as soon as possible.

    Ethics Every Day for Contracted Healthcare Providers and Third Parties

Fraud, Waste, and Abuse Training 

As part of our efforts to improve the healthcare system, CarePlus has made a commitment to detecting, preventing, and correcting fraud, waste, and abuse (FWA). Success in this effort is essential to maintaining a healthcare system that is affordable for everyone. CarePlus has an ongoing campaign to get the word out about how contracted physicians, other healthcare providers, and third parties can help with FWA detection, correction, and prevention. 

 

CMS requires training upon employment or contract and annually thereafter on this topic for those rendering services or supporting those services for a Medicare-eligible beneficiary. CarePlus and our parent company, Humana, have integrated guidance on this topic in two core Humana Compliance Program documents used by CarePlus: 

Compliance Policy for Contracted Healthcare Providers and Third Parties

Ethics Every Day for Contracted Healthcare Providers and Third Parties

For purposes of the relationships that contracted healthcare providers and third parties* have with CarePlus, FWA-related content within these documents, including all references and requirements related to Medicare Part C and Part D, applies to all CarePlus plans. 

Organizations are responsible for developing training on this topic or using other FWA training. However, contracted healthcare providers and third parties supporting CarePlus’ Medicare products may use content from or integrate the above-listed Humana documents in the FWA training they provide to their employees and those supporting their organization. This training allows these contracted healthcare providers and third parties to meet their contractual obligation to CarePlus to train individuals on FWA. 

*CMS designates these as first-tier, downstream, and related entities (FDRs). 

For additional information about FWA, please refer to the link below: 

What are Fraud, Waste, and Abuse?

Prospect of Oversight-related Request

CarePlus reserves the right to request that contracted healthcare providers and those in their organizations supporting a CarePlus contract provide evidence that they have distributed the above documents or materially similar content, tracking logs, documentation related to FWA training, and any other requirements the documents outline.

Questions Related to these Compliance Program Requirements

You can direct any related inquiries to your assigned provider services executive or CarePlus’ Provider Operations inquiry line at 1-866-220-5448, Monday – Friday, 8 a.m – 5 p.m, Eastern time.

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Last Updated:

03/14/2024