Compliance
Table of Contents
Compliance Program
Capital Health Plan’s Compliance Program is composed of eight essential elements. The following represents a brief description of each element. To view Capital Health Plan’s Compliance Program click here.
- Written policies and procedures. CHP’s Compliance Code of Conduct and associated policies are found in the Beacon located on the intranet with related compliance policies, which can be viewed, emailed, or printed. A copy is issued to all workforce upon hire and upon request. Additional clarifications regarding compliance guidance are issued in various CHP communications which may include:
- Network News – CHP’s publication to our provider network
- Healthline – CHP’s publication to our members
- The Source – CHP’s publication to our employees
- Designation of Compliance Officer and Compliance Committee. CHP implemented the role of a Compliance Officer in November 1999, and a Compliance Committee chaired by that Officer since December 1999. The committee meets regularly throughout the year. Additional information regarding responsibilities of the Compliance Committee and/or the Compliance Officer are found in the Beacon.
- Effective training and education. Compliance training is a combinaton of classroom, one-on-one, and computer-based training. All new members of CHP’s workforce generally receive their training on their first day of employment, and no later than their first week. Compliance training is also required for some temporary staff, students, and consultants.
Thereafter, compliance training is an annual event with assignments corresponding to the employee’s job responsibilities and associated risks. Successful training completion requires a minimum score of 80% and all workforce are required to meet this standard. The training material is reviewed on an ongoing basis by the Compliance Department and is shared with the Compliance Committee. - Effective lines of communication. The Compliance Department has an open-door policy and encourages visitors with concerns. Other means of communicaon include email, mail, and phone access. There is a dedicated 24/7 Compliance Hotline at 850.383.3566 available for anonymous reporting.The responsibility to report any violations of CHP’s compliance policies is explained in the Beacon Program, as well as the Non-Retaliation policy for good-faith reporting of suspected violations. Annual compliance surveys, evaluation inquiries, and exit interviews are also communication tools employed by the Compliance Officer.
- Enforcement of Compliance standards. Compliance standards enforcement is the responsibility of all CHP management, and our Code of Conduct adherence is expected of all employees. Failure to comply would result in disciplinary action up to and including termination.
- Conducting internal monitoring and auditing. CHP’s Compliance Department interacts with all departments and oversees all facets of the organization to ensure adherence to the moral, ethical, legal, and regulatory standards that govern our industry. Various reporting tools and collaborative efforts are employed in the oversight process. Research, analysis, auditing, and monitoring of internal/external stakeholders occurs to ensure organizational compliance with all relevant laws and regulatory requirements on both state and federal levels. Reports and findings are shared with the Compliance Committee, Audit Committee of the Board, and any other relevant workgroups or parties.
- Responding promptly to detected offenses and undertaking corrective action. CHP’s Beacon Program requires timely investigation of any reported violations and appropriate disciplinary action as referenced in this document, personnel policies, and the Fraud, Waste, & Abuse Awareness and Reporting Policy.
- Fraud, Waste, and Abuse Training. The Compliance Program detects, corrects, and works to prevent any issues related to fraud, waste, and/or abuse. The Fraud, Waste, and Abuse (FWA) policy is part of new employee training and annual training for all employees. In addition, FWA training is also provided by SIU quarterly.
This summary is not intended to be all-inclusive of the entire scope of Capital Health Plan’s Compliance Program, but is designed to present a high-level overview of the compliance elements currently in place.
Please call the Capital Health Plan Compliance Department at 850-523-7299 should you have any questions regarding this material.
Fraud, Waste, and Abuse Notice Training
The detection, correction, and prevention element for CHP compliance is reflected in the Fraud, Waste, and Abuse Awareness and Reporting Policy found on our intranet, public website, and in the Beacon Program document. This policy is part of workforce orientation during initial on-boarding at CHP. FWA awareness and reporting expectations are part of the initial and annual computer-based compliance training provided to all staff. Fraud Awareness training is also provided on-site by the Florida Blue Special Investigations Unit.
Red Flag Rule - Identity Theft Prevention Policy
The U.S. Department of Health and Human Services, Office of Inspector General, defines Medical Identity Theft as the act of someone stealing or using your personal information (like your name, Social Security number, or Medicare number), to submit fraudulent claims to Medicare and other health insurers without your authorization.
You may access our Identity Theft Prevention Policy at any time.