Compliance

For over 50 years, CCHP has demonstrated a culture of caring for our most vulnerable members as part of an integrated delivery system. As the safetyet provider in Contra Costa County, we endeavor to continue this legacy. In service of our members, Contra Costa Health Plan is strongly committed to meeting ethical standards, contractual obligations, and all applicable statutes, regulations, and rules governing all programs we offer, including our Medicaid (Medi-Cal) and Medicare Advantage and Medicare Prescription Drug programs. We design and monitor our programs to ensure our services support the needs of the populations in Contra Costa County.

Contra Costa Health Plan maintains a Compliance Program that includes the elements of an effective Compliance Program as recommended by the Department of Health and Human Services (DHHS) Office of Inspector General (OIG) as outlined below to ensure all members receive high-quality care.

The Compliance Program includes:

1. The Compliance Plan
2. The Code of Conduct
3. Policies and Procedures

CCHP’s Compliance Program applies to all employees, the Board of Supervisors via members of the Joint Conference Committee, and all first-tier, downstream, and related entities. Compliance is everyone’s responsibility and together we play a critical role in the successful execution of our Compliance Program.

CCHP's Compliance Plan outlines standards and activities to prevent, detect, and correct compliance issues across all business lines. Combined with the Code of Conduct and Policies and Procedures, it forms a Compliance Program incorporating the seven elements recommended by the DHHS Office of Inspector General to meet Medicare and Medi-Cal regulations:

• Standard policies
• Oversight
• Due diligence
• Education
• Monitoring and auditing
• Incentives/enforcements
• Incident response

If you see any activity that you think is fraudulent or wasteful, we strongly encourage you to call:

California Department of Health Care Services – Fraud Reporting

• FWA Hotline Number: 1-800-822-6222

• Email: fraud@dhcs.ca.gov (can report anonymously)

•Mailing Address:

Medi-Cal Fraud Complaint - Intake Unit

Audits and Investigations

PO Box 997413, MS 2500

Sacramento, CA 95899-7413

• Online Reporting: DHCS Fraud Reporting Form: Stop Medi-Cal Fraud

• Hours of Operation: Available 24/7 for reporting.

Contra Costa Health– Compliance Hotline

• FWA Hotline Number: 1-800-304-9490 (can report anonymously)

• Email: compliance@cchealth.org

• Mailing Address:

Contra Costa Health Plan Compliance Unit
595 Center Avenue, Suite 100
Martinez, CA 94553

• Hours of Operation: Available 24/7 for reporting.

What to Include When Reporting

• Names and contact information of individuals or organizations involved.

• Description of the alleged fraudulent activity or abuse.

• Dates and locations where the suspected activity occurred.

• Any supporting documentation or evidence.

Confidentiality: Reports can be made anonymously, and confidentiality is protected to the extent allowed by law.

CCHP will alert its members and providers when a state of emergency is declared by the Governor or the State Public Health Officer. Emergency Operations will be activated within 48 hours. CCHP abides by the Health & Safety Codes (Section 1368.7 and Sec 2) in accordance with Senate Bill 979 and Section 1368.7 of the Health and Safety Code. When the Governor declares an emergency, CCHP staff will follow those guidelines and work with the State and County Public Health Officers.

CCHP’s staff will ensure that accurate information goes to its members and providers.

Contra Costa Health (CCH), has a comprehensive Emergency Operations Response Plan which assigns responsibilities, describes CCH emergency incident command structures and procedures, and provides a concept of operations for Public Health and Medical response during an incident or emergency.

During the Emergency period, CCHP will post information for members on our website and social media pages. CCHP will ensure that members and providers are given the official website for Contra Costa County.