Health Care Compliance Plans for Medical Assistance Providers

Health Care Compliance Plans

As an agency responsible for detecting fraudulent and abusive practices in the Medical Assistance (MA) Program, the Office of Administration's Bureau of Program Integrity strongly encourages the adoption of a compliance plan to prevent and detect violations of law or regulations.

A component of any effective compliance plan is the periodic self audit of billings. This includes the reconciliation of medical assistance claims with the amount received to ensure appropriate payment for the services rendered and in accordance with the medical assistance fee schedule.

In some instances, adoption of a compliance plan may be made a pre-condition to continued participation in the MA Program. Presence or absence of compliance plans is a relevant factor to the Department when considering sanctions.

Partnering in HealthChoices Behavioral Health Program Compliance - Coordinated Training 2012

Additional compliance information may be found on the Healthcare Corporate Compliance Supersite and on the Office of Inspector General's Health and Human Services site.