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:
Centers for Medicare & Medicaid Services
- Medicare Learning Network (MLN) Web-based Training (WBT) Courses
- General Compliance Training [Medicare Managed Care Manual Ch. 21 & Ch. 9, § 50.3.1]
- Fraud, Waste, and Abuse Training [Medicare Managed Care Manual Ch. 21 & Ch. 9, § 50.3.2]
- HPMS Memo dated December 28, 2015 titled: Clarification on Compliance Program Training Requirement
- OIG/GSA Exclusion Checks [Medicare Managed Care Manual Ch. 21 and Ch. 9, § 50.6.8] (See video below)
- Record Retention - maintain documentation for ten (10) years [Medicare Managed Care Manual Ch. 21 and Ch. 9, § 50.3.2 and Ch. 11, § 100.4]
- Standards of Conduct [Medicare Managed Care Manual Ch. 21 & Ch. 9, § 50.1.3]
- Reporting Mechanism [Medicare Managed Care Manual Ch. 21 & Ch. 9, § 50.4.2]
- Downstream Entities [Medicare Managed Care Manual Ch. 21 & Ch. 9, § 50.6.6]
- Offshore Subcontractors [CMS Memo dated September 20, 2007
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.
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