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.

High Level Oversight and Delegation of Authority The MCO must designate a compliance officer and a compliance committee that are accountable to senior management. Employee Training The Medicaid Managed Care Organization must provide for effective training and education for the compliance officer and the organization’s employees. Communication

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  Oversight, Delegation, Oversight and delegation

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