Compliance

We work to prevent, detect, investigate and correct incidents of Fraud, Waste and Abuse in accordance with contractual, regulatory and statutory requirements. We educate our employees and contractors on false claims acts and the roles such laws play in preventing and detecting fraud, waste and abuse in government health care programs.

We take appropriate disciplinary action against employees, providers, subcontractors, consultants, and agents found to have violated our policies or the Code of Conduct and/or committed Fraud, Waste or Abuse.

Please click on the links below for additional information.

Code of Conduct
Nondiscrimination
False Claims Act
Fraud, Waste and Abuse
Privacy & Security of Member Information
Notice of Privacy Practices
Notice of Privacy Practices in Spanish
Conflict of Interest Plan
Authorization to Disclose PHI

As part of the Colorado Access compliance program, we have an obligation to report known or suspected fraud, waste and abuse. We use the terms “fraud,” “waste” and “abuse” defined below as applied to our business.

Some examples include billing for services not ordered or provided, providing false information about membership or eligibility, providing false information about credentials or certifications, and billing for services that were performed by an individual or entity that has been excluded from participation in government health care programs.

If you suspect fraud, waste or abuse, please contact us.

Fraud: An intentional deception or misrepresentation made by a person with the knowledge that the deception could result in some unauthorized benefit to him/herself or some other person.

Waste: Incurring unnecessary costs as a result of deficient management, practices, systems or controls; the over-utilization of services (not caused by criminally negligent actions) and the misuse of resources.

Abuse: Practices that are inconsistent with sound fiscal, business or medical practices, and that result in an unnecessary cost to government programs, or in seeking reimbursement for goods or services that are not medically necessary or that fail to meet professionally recognized standards for healthcare. It also includes member practices that result in unnecessary cost to Medicaid programs.