communicare head

CommuniCare Compliance Program

OH CHS SNP, Inc. [Doing Business As CommuniCare Advantage]

The CommuniCare Advantage, Inc. Compliance program applies to Medicare Part C and Part D. The CommuniCare Advantage Compliance Program is reviewed and updated, as applicable, annually and is approved by the Board of Directors.

The CommuniCare Advantage Compliance Program is a component of the overall CommuniCare Health Services (“CHS” or “Company”) Compliance Program and reinforces the Company’s commitment to comply with all applicable Federal and State standards as well as ethical standards of conduct. The overall CommuniCare Advantage Compliance Program and the Company Code of Conduct and Ethics is endorsed and approved by the CommuniCare Advantage Board of Directors.

The CommuniCare Advantage Compliance Audit Plan is approved by the Audit Committee of the CommuniCare Advantage Board of Directors.

CommuniCare Advantage builds on the foundation established by the Company’s corporate Compliance Program, including:

  • Measures related to mandatory compliance training
  • HIPAA privacy program training, and fraud, waste and abuse (“FWA”) detection
  • Prevention and correction, including a hotline for anonymous reporting
  • Specialized training for functional areas supported by department policies and procedures.
    • A key element in the Compliance Program is the creation of a CommuniCare Advantage Compliance Committee, which is charged with supporting the CommuniCare Advantage Compliance Officer in review and oversight of the CommuniCare Advantage Compliance Program.
    • The Committee is responsible to CommuniCare Advantage’s senior management, the Chief Executive Officer (CEO), and Board of Directors for reviewing the effectiveness of the Compliance Program through self-audits and monitoring of metrics and key indicators, and to ensure prompt and effective corrective actions are taken where deficiencies are noted.
    • The Compliance Officer and the Committee are responsible for escalating compliance deficiencies and ongoing issues of noncompliance to Senior Management, the CEO, and the Board of Directors. CommuniCare Advantage makes the Compliance Plan available to all Plan employees and the Board of Directors, as well as contractors, subcontractors, vendors, agents, and first-tier, downstream and related entities (“FDRs”).
    • The Compliance Officer reserves the right to amend and update components of the Compliance Plan at any time to make changes based on regulatory guidance, enhancements to the program to improve effectiveness.
    • For the purpose of this website, the term “CommuniCare Advantage programs” includes all the Medicare Advantage (“MA”) Part C and Part D Prescription Drug (“Part D”) lines of business, and the term “employees” includes permanent employees, temporary employees, and volunteers of the health plan.
    • All CommuniCare Advantage employees, non-employees and Board of Directors’ members who support CommuniCare Advantage programs must read and understand the content of the Compliance Plan and associated policies and procedures.
    • Written Policies, Procedures, and Standards of Conduct are an integral part of the Plan for information regarding applicability to FDRs.
    • CommuniCare Advantage also maintains disaster and emergency policies for compliance with guidance on minimizing disruptions in access to health care.
    • Please contact the CommuniCare Advantage Compliance department if you have questions regarding information contained in this Compliance Plan.
  • ActionLine: (800) 238-1770
    • To report Fraud, Waste and Abuse please call:
      ActionLine: (800) 238-1770

Last modified: 12/27/2022

Discover the benefits of CommuniCare Advantage.
Call (855)-969-5869 to learn more.
CommuniCare residents call (855)-969-5861.