Compliance Requirements Impact Health Care Providers

Compliance

Health care providers who have Humana-covered Medicare and/or Medicaid patients are contractually obligated to meet compliance program requirements. These requirements include, but are not limited to, having an effective compliance program that incorporates the core elements of Humana’s compliance policy.

Humana’s compliance policy incorporates requirements not only from Humana’s compliance plan, but also from the Centers for Medicare & Medicaid Services (CMS) and from states where Humana has Medicaid business. It outlines what is needed to sufficiently educate and oversee all staff that support a Humana Medicare and/or Medicaid contract. The policy is available on Humana’s website at https://www.humana.com/fraud.

Additionally, a health care provider’s organization must provide assurance that it understands and complies with the policy, or that it has a materially similar program by submitting an attestation form to Humana. The attestation form is available on Humana’s secure provider portal at Humana.com/providers (registration required). Once logged in, the user needs to choose the “Resources” tab and then “Required Compliance Events.” If unable to register, health care providers can download the form here and follow the submission instructions on the form once complete.

Additional information about compliance requirements is also available in a frequently asked questions document at https://www.humana.com/provider/medical-providers/education/whats-new/compliance-requirements.