Medicare Compliance Program

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El Paso Health’s (EPH) compliance efforts are designed to establish a corporate culture promoting prevention, detection, and resolution of questionable conduct in order to conform to all Federal and State laws and regulations, private payer health plan requirements, and EPH’s ethics and business policies.

El Paso Health has a Compliance Program and a Fraud, Waste, and Abuse (FWA) Plan. The plan describes the organization’s commitment to legal and ethical conduct. These efforts are intended to improve operational quality, to ensure the provision of high quality care, and to reduce fraud, waste, and abuse.

El Paso Health expects all employees (“Associates”), First Tier, Downstream, and Related Entities (FDRs) and contracted Providers to comply, identify, report, and assist in the resolution of all concerns relating to applicable laws, regulations, and policies affecting the operations of EPH.

El Paso Health has the following mechanisms for reporting any potential compliance violation, including suspected fraud, waste and abuse, and misleading sales tactics or information. Reports of potential violations made by or about employees, agents, contractors, providers, FDRs, and members are maintained in a confidential manner. These reporting mechanisms are available 24 hours a day, 7 days a week. Reports may also be made anonymously. These reports are never traced. Anyone can make a report without fear of intimidation or retaliation.

EPH Compliance Hotline: 1-888-310-3434

EPH Fraud, Waste, and Abuse Hotline: 1-866-356-8395

You may also report to:

  • Medicare at 1-800-MEDICARE (1-800-633-4227)
  • Federal OIG Fraud Hotline at 1-800-HHS-TIPS (1-800-447-8477)
  • Texas OIG Fraud Hotline at 1-800-436-6184

Visit our Code of Conduct here.

For more information about how El Paso Health maintains the privacy of your health information, please review the Notice of Privacy Practices or call Member Services at 1-833-742-3125, (TTY 1-855-532-3740).

 

 

H3407_website CMS Accepted 10/09/2019