Transcription of Guidelines for Constructing a Compliance Program for ...
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Guidelines for Constructing a Compliance Program for ...
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.
compliance program must be practical in its design, implementation, and enforcement. An effective compliance program with buy-in from the top-down aids in setting the tone for an organization by providing parameters and benchmarks in specific areas as well as identifying vulnerabilities. Additionally, continuous quality monitoring demonstrates an
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