Fraud Waste and Abuse

Compliance Program Requirements for Those Supporting CarePlus Medicare Products

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

Frequently Asked Questions and Answers

The following document and information is provided to help healthcare professionals and provider entities understand the training requirements.

PDFFrequently Asked Questions about Compliance Program Requirements (PDF opens in new window)

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

As part of our efforts to improve the healthcare system, CarePlus has made a commitment to detecting, preventing and correcting Medicare fraud, waste and abuse (FWA). Success in this effort is essential to maintaining a healthcare system that is affordable for everyone. CarePlus continues to spread the word about how physicians, other healthcare professionals and business partners can help combat FWA.

Fraud, Waste and Abuse Training

CMS requires training 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 into these core Humana Compliance Program documents used by CarePlus:

  • Compliance Policy for Contracted Healthcare Providers and Business Partners
  • Ethics Every Day for Contracted Healthcare Providers and Business Partners

For purposes of the relationships that contracted healthcare professionals and business partners* have with CarePlus, content within these documents on fraud, waste and abuse (FWA), including all references and requirements related to Medicare Part C and Part D, is applicable to all CarePlus lines of business.

Organizations are responsible for developing the training on this topic or using another FWA training. However, contracted healthcare professionals and business partners supporting CarePlus’ Medicare products may do the following to meet their contractual obligation to CarePlus to train individuals on the topic of FWA:

  • Use content from or integrate the above-listed Humana documents in the FWA training they provide to their employees and those supporting their organization.

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

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

Compliance Policy for Contracted Healthcare Providers and Business Partners

This policy is refreshed annually and communicates the strong and explicit organizational commitment of CarePlus and our parent company, Humana, to conducting business ethically, with integrity and in compliance with applicable laws, regulations, regulatory guidance and requirements. We require contracted healthcare providers and business partners 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. We require that this document either be adopted for educating their employees and downstream entities supporting CarePlus or that materially similar content be communicated to these audiences.

PDFCompliance Policy for Contracted Health Care Providers and Business Partners(PDF opens in new window) 

Ethics Every Day (Standards of Conduct)

Here we have posted our Ethics Every Day for Contracted Healthcare Providers and Business Partners, which is closely aligned with the standards of conduct for employees of CarePlus and our parent company, Humana. We invite contracted healthcare professionals and business partners to review this information as soon as possible, as it is refreshed annually and we require that this document either be adopted for educating your employees and downstream entities supporting CarePlus or that materially similar content be communicated to them.

PDFEthics Every Day for Contracted Health Care Providers and Business Partners(PDF opens in new window) 

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 of distribution of the above documents or materially similar content, as well as tracking logs, along with documentation related to FWA training or 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 helpline at 1-866-220-5448, Monday through Friday, from 8 a.m. to 4 p.m. Eastern time.