Great Plains Medicare Advantage has adopted a Compliance Program to support the Plan’s mission, vision, and values while complying with the applicable regulatory requirements. The Compliance Program has been developed to assist in establishing a culture within Sanford Health Plan 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 Great Plains Medicare Advantage Compliance Program describes the Plan’s commitment to ethical business practices and behavior. Additionally, the Compliance Program provides the framework to assure that the Plan’s employees, officers, managers, 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 Code of Conduct and requirements to prevent, detect, and mitigate fraud, waste, and abuse (FWA).
The Great Plains Medicare Advantage Compliance Program is specifically tailored to the Plan’s unique operations and circumstances. Certain FDRs provide administrative or health care services for enrollees on behalf of the Plan. FDRs with delegated administrative or health care service functions relating to the Plan’s Medicare Parts C and D contracts are required to meet all Medicare program requirements.
Great Plains Medicare Advantage has implemented a Code of Conduct that states the overarching principles and values by which Great Plains Medicare Advantage operates and defines the underlying framework for our Compliance Program.
Great Plains Medicare Advantage Code 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 Code of Conduct communicates to employees and FDRs that compliance is everyone’s responsibility, no matter what position they hold.
Great Plains Medicare 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 to our Medicare beneficiaries. As a part of these contracts, CMS requires Great Plains Medicare Advantage to oversee our first tier, downstream, and related entities (FDRs) who provide health care or administrative services.
As an FDR for Great Plains Medicare Advantage, you are an important partner in the continued success of our Compliance program.
Medicare requires FDRs to participate in the Great Plains Medicare Advantage Compliance program, and we are committed to providing you with the tools needed to ensure you meet the obligations of this program. Our Code of Conduct and other resources for reporting concerns or issues are available to you.
CMS requires our FDRs to complete Medicare FWA and general compliance training on an annual basis.
In accordance with CMS guidance, providers who have enrolled in Medicare Parts A or B or are accredited as Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) suppliers are deemed to have met the requirement for the FWA training and education. However, this does not exempt your organization from having to complete the general compliance training on an annual basis.
In order to ensure consistency and reduce the burden on providers, suppliers, contractors, and organizations, CMS has developed a web-based training module that can be used to satisfy the FWA and the general compliance training and education requirements.
FDRs must satisfy CMS’ general compliance and FWA training requirements. FDRs can complete the general compliance and/or FWA training modules available through the CMS CMS Medicare Learning Network (MLN). Or, FDRs may download, view or print the content of the CMS standardized training modules from the CMS website to incorporate into their organization’s existing compliance training materials/systems. The CMS training content cannot be modified to ensure the integrity and completeness of the training.
Regardless of the training program used, Great Plains Medicare Advantage requires FDR agents to complete the FWA training within 90 days of contracting with Great Plains Medicare Advantage and annually thereafter.
Thank you for your cooperation. If you have any questions about whether your organization is required to complete FWA and general compliance training, or whether your organization’s internal training or third-party training is sufficient, please contact the Great Plains Medicare Advantage Compliance Officer at firstname.lastname@example.org.
Great Plains Medicare Advantage maintain a Compliance Hotline. The Compliance Hotline provides a mechanism for callers to report activity related to known or suspected non-compliance with the law, regulation of Great Plains Medicare Advantage Policy. All calls to the Compliance Hotline will be treated as confidential and private to the fullest extent possible.
Compliance Hotline: 1-877-473-0911 (TTY: 711)
If you are not comfortable or able to make a report via the Compliance Hotline, you may send a written report by mail to:
4800 West 57th Street
Sioux Falls, SD 57108
Or Email: email@example.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 Great Plains Medicare 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 Great Plains Medicare Advantage Policy.
Want more information about Great Plains Medicare Advantage?
Call us at 1-844-637-4760 (TTY 888-279-1549).
Our trained member service representatives are available from 8:00 a.m. to 8:00 p.m., or fill out this contact me form to have us call you.