Fraud Waste and Abuse

Compliance Program Requirements for Those Supporting CarePlus Medicare Products

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

Frequently Asked Questions and Answers

The following document and information below is provided to help health care professionals and provider entities complete these requirements.

PDFFrequently Asked Questions about Compliance Program Requirements (link 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. So 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 health care system, CarePlus has made a commitment to detecting and preventing Medicare fraud, waste and abuse (FWA). Success in this effort is essential to maintaining a health care system that is affordable for everyone. CarePlus continues to spread the word about how physicians, other health care professionals and business partners can help with FWA detection, prevention and correction.

Fraud, Waste and Abuse Training and General Compliance Training

CarePlus and our parent company, Humana, have adopted a training document published and required by the Centers for Medicare & Medicaid Services (CMS) that addresses this subject matter. For purposes of the relationships that contracted health care professionals and business partners* have with CarePlus, this training, including all references and requirements related to Medicare Part C and Part D, is applicable to all CarePlus lines of business.

Contracted health care professionals and business partners supporting CarePlus’ Medicare products must use CMS content on these two topics to train their employees and those supporting their organization to meet certain contractual obligations to CarePlus.

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

Accessing the CMS Training File

  1. Navigate to https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/ProviderCompliance.html (link opens in new window) .
  2. Scroll to the “Fraud and Abuse-related Resources” section.
  3. Click on “Medicare Parts C and D Fraud, Waste, and Abuse Training and Medicare Parts C and D General Compliance Training.” This opens a PDF with links to the training.
  4. The training is available in PDF format for printing or download via separate files for each topic.

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

Compliance Policy for Contracted Health Care Providers and Business Partners

This policy 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 health care 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.

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

Ethics Every Day (Standards of Conduct)

Here we have posted our Ethics Every Day for Contracted Health Care 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 health care professionals and business partners to review this information as soon as possible, as we require that this document either be adopted for their employees and downstream entities supporting CarePlus or that materially similar content be communicated to these audiences.

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

Attestation Process

Once you have reviewed all the information outlined above, please note that a signed, CarePlus attestation form must be submitted to CarePlus. The attestation is intended to be completed at the contract level; as such, if your organization has multiple tax identification numbers (TINs) under one group contract, please complete one form and list each TIN on that form.

PDFCarePlus Compliance Requirements Attestation Form (link opens in new window)

You may submit the completed attestation form via any of the methods outlined below:

Mail Email Fax

CarePlus Health Plans, Inc. 11430 NW 20th St., Suite 300 Miami, FL 33172 Attention: Provider Operations Dept.

CPHPProvOpsCompliance@careplus-hp.com 1-866-449-5668