New Claims System Update

Provider Manual
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13 COMPLIANCE AND ETHICS

13.1 General Obligation to Prevent, Detect and Deter Fraud, Waste and Abuse

As a recipient of funds from state and federally sponsored health care programs, IntegraNet has a duty to help prevent, detect and deter fraud, waste and abuse. IntegraNet is committed to detecting, mitigating and preventing fraud, waste and abuse as outlined in its Corporate Compliance Program. As part of the requirements of the federal Deficit Reduction Act, each provider is required to adopt IntegraNet policies on detecting, preventing and mitigating fraud, waste and abuse in all the federally and state funded health care programs in which IntegraNet participates.

The IntegraNet policy on fraud, waste and abuse prevention and detection is part of the IntegraNet Corporate Compliance Program. Electronic copies of this policy and IntegraNet Code of Business Conduct and Ethics can be found on the website at www.IntegraNethealth.com/fwa.

IntegraNet maintains several ways to report suspected fraud, waste and abuse. As a Medicare Advantage provider and a participant in government-sponsored health care, you and your staff are obligated to report suspected fraud, waste and abuse. These reports can be made anonymously at https://www.IntegraNetHealth.com/fwa or by calling 1-855-535-1907. In addition to anonymous reporting, suspected fraud, waste and abuse may also be reported via email to [email protected]. You can also reach out directly to the IntegraNet Chief Compliance Officer at 1-855-535-1907 or send an email to [email protected].

In order to meet the requirements under the Deficit Reduction Act, you must adopt the IntegraNet fraud, waste and abuse policies and distribute them to any staff members or contractors who work with IntegraNet. If you have questions or would like more details concerning the IntegraNet fraud, waste and abuse detection, prevention and mitigation program, please contact the IntegraNet Chief Compliance Officer.