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2012 Compliance: Fraud, Waste and Abuse (training - Ubhonline.com

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Seven Elements of an Effective <strong>Compliance</strong> Program<br />

• Federal law requires Medicare Advantage <strong>and</strong> Part D plan sponsors to<br />

implement <strong>and</strong> maintain an effective <strong>com</strong>pliance program that<br />

incorporates measures to detect, prevent, <strong>and</strong> correct fraud, waste, <strong>and</strong><br />

abuse.<br />

• The Health & Human Services (HHS) Office of Inspector General (OIG) has<br />

identified seven core elements of a <strong>com</strong>pliance program:<br />

1. Written St<strong>and</strong>ards of Conduct – An organization’s Code of Conduct,<br />

policies, procedures <strong>and</strong> other written operating guidelines.<br />

2. High Level Oversight – designate a leader(s), including an established<br />

<strong>com</strong>pliance <strong>com</strong>mittee, responsible for implementing <strong>and</strong> monitoring the<br />

<strong>com</strong>pliance program.<br />

3. Effective Training <strong>and</strong> Education – develop <strong>and</strong> implement regular<br />

<strong>and</strong> effective <strong>training</strong> programs, such as this one.<br />

Confidential property of Optum. Do not distribute or reproduce without express permission from Optum.<br />

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