Compliance

AgeRight Advantage is committed to acting with integrity and making decisions based on the highest standards of ethical behavior, including complying with applicable laws and regulations.

To ensure the provision of quality health care services in compliance with these laws, AgeRight Advantage has developed a compliance program that provides guidelines and assigns responsibilities for controls and procedures that promote consistent and proper organizational behavior.

The Compliance Program has been developed to assist in establishing a culture within AgeRight Advantage 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 Compliance Program describes our commitment to ethical business practices and behavior. Additionally, the Compliance Program provides the framework to assure that our employees, including officers, managers, volunteers, 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 Standards of Conduct and requirements to prevent, detect, and mitigate fraud, waste, and abuse (FWA).

 

Medicare FWA & General Compliance Training

AgeRight Advantage contracts with the Centers for Medicare and 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 NHC Advantage to oversee FDRs who provide health care or administrative services.

FDRs are an important partner in the continued success of our Compliance program.

Medicare requires FDRs to participate in the AgeRight Advantage Compliance Program, and we are committed to providing FDRs with the tools needed to ensure FDRs meet the obligations of this program. AgeRight Advantage Standards of Conduct and other resources for reporting concerns or issues are available by clicking the link below.

While Medicare FWA and General Compliance training for FDRs is not required by the Centers for Medicare and Medicaid Services (CMS), FDR agents (e.g., office staff and other personnel associated with or employed by an FDR) are expected to be in compliance with all applicable laws, rules, and regulations, and Medicare requirements.

Contact the AgeRight Advantage Compliance Officer at [email protected] with any questions about the AgeRight Advantage Compliance Program.

Compliance Hotline

AgeRight Advantage has implemented a Compliance Hotline for our Members; employees; first-tier, downstream, and related entities; and other contractors and agents.

The Compliance Hotline provides a mechanism for callers to report activity related to known or suspected non-compliance with AgeRight Advantage’s mission; policies and procedures; Compliance program; Standards of Conduct; or any Federal, State, or local laws and regulations.

All calls to the Compliance Hotline will be treated as confidential and private to the fullest extent possible.

Compliance Hotline: 1-844-317-9059 (toll free)

If you are not comfortable or able to make a report via the Compliance Hotline, you may send a written report by mail to:

Nicole Burnham
AgeRight Advantage
PO Box 4440
Glen Allen, VA 23058-4440

Or Email: [email protected]
Or Fax: 1-833-572-2367

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 AgeRight 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 AgeRight Advantage Policy.