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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 third parties can help combat FWA.
CMS requires training upon employment or contract and annually thereafter 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 in core Humana Compliance Program documents used by CarePlus:
For purposes of the relationships that contracted healthcare professionals and third parties* have with CarePlus, FWA-related content within these documents, including all references and requirements related to Medicare Part C and Part D, applies to all CarePlus plans.
Organizations are responsible for developing training on this topic or using other FWA training. However, contracted healthcare professionals and third parties supporting CarePlus’ Medicare products may use content from or integrate the above-listed Humana documents in the FWA training they provide to their employees and those supporting their organization. This training allows these contracted healthcare professionals and third parties to meet their contractual obligation to CarePlus to train individuals on FWA:
*CMS designates these as first-tier, downstream and related entities (FDRs).
For additional information about FWA, please refer to the link below:
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 third parties 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.
Below we have posted our Ethics Every Day for Contracted Healthcare Providers and Third Parties, which contain the standards of conduct for employees of CarePlus and our parent company, Humana. We invite contracted healthcare professionals and third parties to review this information as soon as possible, 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 these audiences.
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 that they have distributed 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 inquiry line at 1-866-220-5448, Monday – Friday, 8 a.m. – 5 p.m., Eastern time.