As a community health plan that values partnership, service excellence community and personal relationships, we are committed to doing the right thing. We have a Compliance Program and Fraud Waste and Abuse (FWA) Plan that we follow to ensure we comply with State and Federal laws, regulations, and our internal policies and procedures.
Please help us stop health care fraud. In this section, we provide useful tools to help us fight health care fraud. If you are a PacificSource member, provider or contractor, please report suspicious activities to us immediately. Thank you for your continued support. We are committed to serving our members in the best and most ethical manner.
For more information, including how to recognize these activities, how to report them, and ways you can help prevent health care fraud, please click on the tab above that applies to you.
We maintain a comprehensive Compliance Program that allows us to carry out the activities needed to support our culture of compliance. The Compliance Program includes important topics such as:
We also have a Standards of Conduct which includes our written commitment to compliance and ethical behavior. The Standards of Conduct has been approved by our Board of Directors and Executive Management. This document provides information on things such as:
PacificSource Code of Conduct
PacificSource Compliance and Program Integrity Plan
We maintain a comprehensive work plan that focuses on higher risk activities. This plan allows us to monitor the activities of our internal operations, external vendors, providers, and other areas of our business. Thank you for your cooperation in providing information in an accurate and timely manner if you are identified in our work plan.
Health care fraud is a growing problem. It drives up the cost of health care, and puts a burden on taxpayers and the health care system. We are committed to stopping health care fraud. To help us protect you against fraudulent claims and practices, we have included examples of activities you should look for:
If you see any of these activities, please contact us immediately. We will look into and work with State and Federal government agencies about your concerns.
Below are documents and websites with tips and important information on how to protect yourself against fraudulent activities. This includes how to spot fraud and how to report your concerns.
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Health care fraud is a growing problem. It drives up the cost of health care, and puts a burden on tax payers and the health care system. We are committed to combating health care fraud. You can help us to prevent, detect, and correct noncompliance and fraud, waste, and abuse (FWA).
If you suspect noncompliance or FWA activities, you must report them to us by calling (800) 624-6052 ext. 2580 or emailing providerservicerep@pacificsource.com. You may also report anonymously by contacting EthicsPoint (a PacificSource vendor) 24 hours a day/seven days a week at (888) 265-4068.
Here are some common examples of noncompliant and FWA activities:
You and your employees are required to take general compliance and FWA training annually. If you have met the fraud, waste, and abuse certification requirements through enrollment into the Original Medicare program, you do not have to take the FWA Training. If you and your employees have taken the training for other Medicaid Managed Care, or Medicare Advantage health plans, you do not have to take PacificSource’s training.
For your convenience, we have provided you with the following training modules.
PacificSource Code of Conduct
PacificSource Compliance and Program Integrity Plan
OIG Compliance and FWA Training
You must ensure that all of your employees and any downstream entities (i.e., subcontractors) take both of these CMS-approved training modules annually and read our Compliance Program and Standards of Conduct. All new employees and any downstream entities (i.e., subcontractors) must complete this as part of their orientation within 90 days of hire. Please document and retain proof of completion. You must use the Training Attendance Log to track your completion. If your employees and any downstream entities (i.e., subcontractors) have taken a CMS-approved training for other Medicaid Managed Care health plans, you do not have to take PacificSource’s CMS-approved training. However, they must still document their completion using the other health plan’s Training Attendance Log, or a modified version thereof. You do not need to send anything to PacificSource. However, your proof of training attendance and completion will be subject to PacificSource audit and verification.
If you have any questions about the content of this page, you may contact your provider service representative at (800) 624-6052 ext. 2580 or providerservicerep@pacificsource.com.
Below are documents and websites that provide you with tips and information on how to protect you and your patients against fraudulent activities, including how to detect and report them.
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Health care fraud is a growing problem. It drives up the cost of health care, and puts a burden on tax payers and the health care system. We are committed to combating health care fraud. You can help us to prevent, detect and correct noncompliance and fraud, waste and abuse (FWA).
If you suspect noncompliance or FWA activities, you must report them by contacting us. You may also report anonymously by contacting EthicsPoint (a PacificSource vendor) 24 hours a day, seven days a week at (888) 265-4068.
Here are some common examples of noncompliant and FWA activities:
You and your employees are required to take general compliance and FWA training. If you and your employees have taken the training for other Medicaid Managed Care, or Medicare Advantage health plans, you do not have to take PacificSource’s training.
For your convenience, we have provided you with the following training modules.
PacificSource Code of Conduct
PacificSource Compliance and Program Integrity Plan
OIG Compliance and FWA Training
You must ensure that all of your employees and any downstream entities (i.e., subcontractors) take both of these CMS-approved training modules annually and read our Compliance Program and Standards of Conduct. All new employees and any downstream entities (i.e., subcontractors) must complete this as part of their orientation within 90 days of hire. Please document and retain proof of completion. You must use the Training Attendance Log to track your completion. If your employees and any downstream entities (i.e., subcontractors) have taken a CMS-approved training for other Medicaid Managed Care health plans, you do not have to take PacificSource’s CMS-approved training. However, they must still document their completion using the other health plan’s Training Attendance Log, or a modified version thereof. You do not need to send anything to PacificSource. However, your proof of training attendance and completion will be subject to PacificSource audit and verification.
If you have any questions about the content of this page, please contact us.
Listed below are documents and websites that provide you with tips and information on how to protect yourself against fraudulent activities, including how to detect and report them.
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