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.

Written Policies and Procedures - Critical to the compliance program is the development of written policies and procedures, standards, and documentation of practices that govern the Medicaid managed care organization’s efforts to identify risk and areas of vulnerabilities. Usually, this is the most time consuming part of developing a compliance

  Programs, Medicaid, Policies, Procedures, Policies and procedures