Compliance
Simpra Advantage Plan Compliance
We are committed to acting with integrity and making decisions based on the highest standards of ethical behavior, including complying with applicable laws and regulations.
To ensure the provision of quality health care services in compliance with these laws, Simpra Advantage has developed a compliance program that provides guidelines and assigns responsibilities for controls and procedures that promote consistent and proper organizational behavior.
The Compliance Program has been developed to assist in establishing a culture within Simpra Advantage that promotes the prevention, detection, and resolution of instances of conduct that do not conform to federal and state law and federal and state health care program requirements.
The Compliance Program describes our commitment to ethical business practices and behavior. Additionally, the Compliance Program provides the framework to assure that our employees, including officers, managers, volunteers, interns, Board of Directors, vendors (contractors, subcontractors), and first-tier, downstream, and related entities (FDRs) comply with the applicable legal and ethical standards of conduct, including our standards of conduct and requirements to prevent, detect, and mitigate fraud, waste, and abuse (FWA).
Standards of Conduct
Simpra Advantage has implemented a Standard of Conduct that states the overarching principles and values by which Simpra Advantage operates and defines the underlying framework for our Compliance Program.
The Simpra Advantage Standards of Conduct describes our expectations that:
- All employees and first tier, downstream, and related entities (FDRs) conduct themselves in an ethical manner.
- Issues of noncompliance and potential fraud, waste, and abuse (FWA) are reported through appropriate mechanisms.
- Reported issues will be addressed and corrected.
The Standards of Conduct communicates to employees and FDRs that compliance is everyone’s responsibility, no matter what position they hold.
Medicare FWA & General Compliance for FDRs
Simpra Advantage contracts with the Centers for Medicare & Medicaid Services (CMS) to provide health care and prescription drug benefits under Medicare Advantage and Medicare Part D Programs for our members. As part of these contracts, CMS requires Simpra Advantage to oversee its First-Tier, Downstream and Related Entities (FDRs) who provide health care or administrative services to our members and on behalf of Simpra Advantage. FDRs are an important partner in continued success of Simpra Advantage and our Compliance Program.
As part of the CMS General Compliance and FWA training requirements that Simpra Advantage must adhere to, FDRs must also complete this training within 90 days of engagement and annually thereafter. FDRs can complete this training through the modules available on the CMS Medicare Learning Network (MLN). Or, by completing the training available on the CMS website. Note that the training content cannot be modified to ensure the integrity and completeness of the training.
If you have any questions regarding FDRs and Medicare General Compliance and FWA training, please contact the Simpra Advantage Chief Compliance Officer at [email protected].
Compliance Hotline
Compliance Hotline: 1-833-416-5035 (toll free)
Simpra Advantage has implemented a Compliance Hotline for our Members; employees; first-tier, downstream, and related entities; and other contractors and agents.
The Compliance Hotline provides a mechanism for callers to report activity related to known or suspected non-compliance with Simpra Advantage’s mission; policies and procedures; Compliance program; Standards of Conduct; or any Federal, State, or local laws and regulations.
All calls to the Compliance Hotline will be treated as confidential and private to the fullest extent possible.
Compliance Hotline: 1-833-416-5035 (toll free)
If you are not comfortable or able to make a report via the Compliance Hotline, you may send a written report by:
Celeste Panaro
Simpra Advantage
Attn: Compliance Department
PO Box 1847
Birmingham, AL 35201
Or Fax: 1-205-994-7028
Or Email: [email protected]
Or Visit: SimpraAdvantage.ethicspoint.com
Whether reporting by telephone or in writing, please provide as much detail as possible, including, but not limited to, names, dates, times, locations, and the specific conduct you feel may violate the law or Simpra Advantage Policy.
No individual making a good faith report of a suspected violation shall be retaliated against. However, any individual who knowingly makes a false allegation shall be subject to disciplinary action in accordance with Simpra Advantage policy.