Medicare compliance

Providence Medicare Advantage Plans is committed to a “culture” of compliance. As part of our contract with The Centers for Medicare & Medicaid Services (CMS), we have developed and adopted an effective compliance program. Our compliance program reinforces our commitment to ethical standards and conduct, and establishes our expectation that all Providence Medicare Advantage Plan employees, governing board, first tier, downstream, related entities and members conduct themselves in an ethical and lawful manner, and comply with all federal, state and local laws and regulations.

What is compliance and why is it important?

Compliance can be defined as efforts fundamentally designed to establish a culture within an organization that promotes the prevention, detection and resolution of instances of conduct that do not conform to federal and state law, or to federal health care program requirements.

Compliance demonstrates Providence Medicare Advantage Plans’ commitment to honesty and integrity, while helping fulfill our legal duty and contractual obligations to the government. Compliance with CMS regulations ensures consistent and fair treatment of all of our members.

What are examples of non-compliance?

  • We failed to safeguard the privacy of your information
  • We violated CMS marketing provisions
  • We failed to provide services in a culturally competent manner
  • We didn’t notify you that we were denying payment for services that you received
  • You asked for a referral to see a specialist, and it took longer than 14 days

How can you report potential Medicare non-compliance concerns?

Please fill out the potential non-compliance external referral form (PDF)

  • Send by fax to: 503-574-6543

    OR

  • Send by mail to:
    Attention: Medicare Compliance Program Manager
    3601 SW Murray Blvd, Suite 10
    Beaverton, Oregon 97005


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