Guidelines for Constructing a Compliance Program for ...

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Guidelines for Constructing a Compliance Program for Medicaid Managed Care Organizations and PrePaid Health Plans A Product of the Medicaid Alliance for Program Safeguards May 2002 Guidelines For Constructing A Compliance Program for Medicaid Managed Care Organizations and Prepaid Health Plans In June 1997, CMS s Southern Consortium assumed leadership of the Medicaid Alliance for Program Safeguards (Alliance). This Alliance was established with the primary goal of preventing fraud and abuse by assisting States in their efforts, identifying proactive strategies, and sharing information with other Program integrity players. Through leadership, the Alliance strives to encourage participation and communication among State and Federal entities working to fight fraud and abuse.

the designation of a top-level staff member to oversee compliance efforts, the allocation of resources as necessary, and the creation of a compliance committee. This person often termed the Compliance Officer is responsible for program oversight and ensuring the overall development, implementation and success of the program. To be effective as a

  Compliance