Partners’ Regulatory Compliance Unit is responsible for compliance relating to health care fraud, waste, and financial abuse, health information management, and the Health Insurance Portability and Accountability Act (HIPAA). The Regulatory Compliance Unit offers education and training to providers on a variety of regulatory compliance-related topics.
Primary Areas Covered by Regulatory Compliance
Regulatory Compliance deals with the prevention, detection, investigation, resolution and reporting of suspected health care fraud, financial waste and abuse, HIPAA Privacy, and HIPAA Security violations.
Reporting Fraud, Waste, Abuse and HIPPA violations
As part of Partners’ overall Regulatory Compliance Program, we have established a dedicated department–The Office of Program Integrity–that focuses on prevention, detection and resolution of health care fraud, waste and financial abuse.
Additionally, Partners has a designated HIPAA Privacy Officer as well as a HIPAA Security Officer. These individuals focus on prevention, detection and resolution of violations related to confidentiality laws, including HIPAA.
If you suspect wrongdoing or questionable practices of:
- Consumers served within our network, or
- Providers within the Partners’ Network,
PLEASE REPORT IT!
Practices may include, but are not limited to:
- Billing for services not provided,
- Conflicts of interest,
- Abuse of public funds,
- Violations and/or health information confidentiality rules, and/or
- Ethical conduct violations.
You may report wrongdoing or questionable practices to the Partners Regulatory Compliance AlertLine at 1-866-806-8777. Or, you can report your concern by visiting the AlertLine webpage at https://partnersbhm.alertline.com. At no time will you be required to give your name. However, providing a name and contact number may allow investigators to contact you in the event additional information is needed. Reporting Medicaid fraud or financial abuse will not interfere with an enrollee’s access to health care.
If you suspect other forms of Medicaid fraud or abuse is happening, you can:
- Contact the Division of Medical Assistance by calling 1-800-662-7030 (English and Espanol), or
- Call the Medicaid fraud, waste and program abuse tip-line at 1-877-DMA-TIP1 (1-877-362-8471)
Want to learn more? Check out the resources below:
- Partners Regulatory Compliance Program Description
- Applicable Laws and Regulations for Regulatory Compliance
- US Office of Inspector General Website
- Office of Inspector General 2017 Workplan
Provider agencies must develop a Corporate Compliance Plan that includes procedures designed to guard against health care fraud and abuse. To learn more details, please refer to the Provider Operations Manual.