What is CVS Health’s compliance and integrity program?
Jan 01, 2022 · Patrick Jeswald Director, Compliance Program Medicare Part D [email protected] Phone: 480-661-2030 Fax: 480-314-6974 9501 E Shea Blvd...
What is Medicare Part C and D plan sponsors compliance training?
The Sponsor must designate a compliance officer and a compliance committee accountable and responsible for the activities and status of the compliance program, including issues identified, investigated, and resolved by the compliance program.
Who is responsible for compliant Medicare compliance?
Medicare Part D Chief Compliance Officer for Silver Script Insurance Company Director - Compliance Program Medicare D CVS Health Jan 2008- Aug 20135 years 8 months Manager, Pharmacy Performance -...
What happens if CVS does not comply with CIA requirements?
• A Part D plan sponsor or applicant • A first tier entity These arrangements continue down to the level of the ultimate provider of both health and administrative services . A related entity is any party that holds common ownership or control of an MA organization or Part D sponsor and: • Performs some of the MA organization or Plan D
Who is CVS Chief Medicare Compliance Officer?
Guidance can be found on the CVS Health® intranet site. In the unlikely event a waiver of, or amendment to, the Code seems to be necessary, contact the Chief Compliance Officer David Falkowski via email ([email protected]) or phone (401) 770-7486.
Who is Patrick jeswald?
Patrick Jeswald is our dedicated Medicare Compliance Officer. You can send questions or concerns to him at [email protected].
What guidelines must colleagues follow when providing gifts CVS?
CVS Health policy allows colleagues to accept occasional, unsolicited gifts of appreciation of nominal value from customers. Antitrust laws are designed to protect competition by prohibiting monopolies, price fixing, predatory pricing and other practices that restrain trade.
What is CVS ethics line?
The CVS Health Ethics Line is available twenty four (24) hours a day, seven (7) days a week by calling 877-CVS-2040 (877-287-2040). CVS Health prohibits retaliating against anyone for raising, in good faith, a legal or ethical concern or cooperating with an investigation.
Which colleagues at CVS are permitted to speak with the news media on the company's behalf?
1. Consistent with the Company's approach to interacting with the traditional news media, only designated CVS Health employees are authorized to speak on behalf of the Company in social media.Sep 5, 2018
What steps should you follow to seek guidance or report issues related to code of conduct?
What steps should you follow to seek guidance or report issues? When you have an issue consult with your supervisor. You should remember that CVS has a strict policy of NO retaliation. If you're a supervisor and need help addressing an issue call the Ethics line.
Why is it important to complete data entry while the customer is present?
Completing data entry through adjudication while the customer is present is critical as it helps to identify any issues, provides you an opportunity to resolve the issue, and provides a positive customer experience. During data entry, the insurance review and hardcopy scanning are also performed.
What is a sales agent FDR?
sales agent, employed by the Sponsor’s first-tier, downstream, or related entity (F DR), submitted an application for processing and requested two things: 1) to back-date the enrollment date by one month, and 2) to waive all monthly premiums for the beneficiary. What should you do?
What is Medicare Advantage?
Medicare Part C, or Medicare Advantage (MA), is a health insurance option available to Medicare beneficiaries. Private, Medicare-approved insurance companies run MA programs. These companies arrange for, or directly provide, health care services to the beneficiaries who enroll in an MA plan.
Dan Finke
Executive Vice President, CVS Health and President, Health Care Benefits Segment (HCB), Aetna
Thomas M. Moriarty
Executive Vice President, Chief Policy and External Affairs Officer, and General Counsel, CVS Health
Michelle Peluso
Executive Vice President and Chief Customer Officer, CVS Health and Co-President, CVS Pharmacy
What is CMS compliance?
CMS believes that compliance efforts are 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 healthcare program requirements. This compliance program guidance is intended to assist Medicare fee-for-service Contractors in developing and implementing effective compliance programs that promote adherence to, and allow for, the efficient monitoring of compliance with all applicable statutory, regulatory and Medicare program requirements. CMS, in its ongoing effort to work collaboratively with the Medicare fee-for-service Contractors, has developed these compliance guidelines as a demonstration of CMS’ commitment to compliance.
What is a contractor's compliance policy?
The Contractor should have comprehensive written compliance policies and procedures, developed under the direction of the Compliance Officer (CO) and Compliance Committee, which direct the operation of the compliance program. The policies and procedures may be Medicare-specific stand-alone documents or may be drafted as Medicare supplements to corporate policies and procedures.
What are the disciplinary policies of a contractor?
The Contractor should maintain written policies that apply appropriate disciplinary sanctions on those officers, managers, supervisors, and employees who fail to comply with the applicable statutory and Medicare program requirements, and with the Contractor’s written standards of conduct. These policies should include not only sanctions for actual non-compliance, but also for failure to detect non-compliance when routine observation or due diligence should have provided adequate clues or put one on notice. In addition, sanctions should be imposed for failure to report actual or suspected non-compliance.
What should a contractor have in a CMS contract?
The Contractor should have a policy that describes the retention schedule for Medicare documents and records in accordance with CMS requirements. Documents identified by the CMS General Counsel’s office, the Department of Justice or the Office of Inspector General as being related to an investigation or other litigation should be retained in accordance with the requests of those offices.
How long does it take to report Medicare fraud to CMS?
However, where the CO has credible evidence of misconduct from any source and has reason to believe that the misconduct may violate criminal, civil or administrative law relating to the Medicare program, then the Contractor should report the misconduct to the OIG and CMS within 30 days of discovering the misconduct. The contractor should have written procedures on how and when misconduct will be referred to CMS or law enforcement authorities.
What is the responsibility of a CO?
The Contractor should designate a CO whose primary responsibility is to oversee the implementation and maintenance of the compliance program. The CO should have adequate authority and independence within the organizational structure in order to make reports directly to the board of directors and/or to senior management concerning actual or potential cases of non-compliance. The CO must also report directly to corporate governance on the effectiveness and other operational aspects of the compliance program.The CO’s responsibilities should encompass a broad range of duties including but not limited to the investigation of alleged misconduct, the development of policies and rules, training officers, directors and staff, maintaining the compliance reporting mechanism and closely coordinating with the internal audit function.