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Compliance toolkit

The Toolkit provides compliance and privacy training information for Security Health Plan’s First tier, Downstream and Related entities (FDRs) to enter into or maintain a business relationship.

How to report

  • Fill out a Fraud Waste and Abuse investigation form

  • Call our compliance hotline 715-221-9570 or 855-274-5540

First tier, Downstream and Related entities (FDRs) Resources

Security Health Plan’s commitment to compliance includes ensuring that our contracted business partners who are FDRs under the Medicare Advantage program also observe all applicable laws, regulations, and sub-regulatory guidance.  Oversight of FDRs is a CMS requirement for all Medicare Advantage plan sponsors. 
 
The CMS training includes, but is not limited to the following: 

Resources

Centers for Medicare & Medicaid Services

Medicaid

Interactive resources

Preventing Fraud, Waste & Abuse – The Office of Inspector General’s (OIG) mission is to protect the integrity and welfare of the program and for the program beneficiaries.  Below is a useful OIG widget to provide our partnering physicians and subcontractors with the information and training as it pertains to fraud and abuse. 

Eye on Oversight: Exclusions
The HHS OIG has authority to exclude, or ban, individuals and entities from participating in Federal health care programs. Employers must check that they are not employing an excluded individual because they may face a financial penalty. This video also covers OIG’s exclusions database, and possible reinstatement. 

OIG Provider Compliance Training at oig.hhs.gov

 

     Video

Privacy and security information

Call our privacy number 715-221-6622 or 766-339-0289

The U.S. Department of Health and Human Services (DHHS) has provided three resources to help you understand your responsibility to protect privacy.

Guide to Privacy and Security of Electronic Health Information – DHHS Office of the National Coordinator for Health Information Technology

Summary of the HIPAA Privacy Rule - DHHS Office for Civil Rights

Summary of the HIPAA Security Rule- DHHS Office for Civil Rights

Disclaimer: These educational materials were current at the time they were published and posted to Security Health Plan's Web site. They were prepared as educational resources; they are not intended to create any rights, privileges, or benefits. Although every reasonable effort has been made to ensure the accuracy of the information within these materials, the ultimate responsibility for complying with Federal and state laws lies with the provider of services. Security Health Plan employees, agents, and staff make no representation, warranty, or guarantee that these compilations of information are error free and will bear no responsibility or liability for the results or consequences of their use. These materials are summaries that explain certain aspects of the laws, but are not legal documents. The official information is contained in the relevant laws and regulations.

Dual Eligible Model of Care Training

View the dual eligible modal of care training presentation.

View the presentation