What is a potential compliance issue?

A potential compliance issue may include concerns in the following areas:

• Suspected fraud, waste or abuse.
  • For example: Provider duplicate billing for services.
• Health Insurance Portability and Accountability Act of 1996 (HIPAA) privacy disclosures of protected health information.
  • For example: Patient letters sent to another person.
• Non-compliance with regulations and laws.
  • For example: Operational or ethical concern with a process.

When should I report the issue to the Alliance?

You should report the issue immediately upon discovery to the Alliance. We are required to investigate this issue and report to the applicable regulatory agencies within a certain timeframe.

HIPAA privacy issues should be reported to the Alliance the same day upon discovery. We are required to report these issues to the state agency within 24 hours of discovery.

How do I report the issue to the Alliance?

There are a few ways in which you can report the issue to the Alliance:

• Fill out the Alliance Compliance Incident Report Form, and email it back to us.
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• You may also report by calling the Alliance Compliance Department Hotline. Callers can choose to report issues anonymously.

Alliance Compliance Hotline
24 hours a day, 7 days a week
Toll-Free: 1.855.747.2234

For examples of health care fraud, please see Fraud Prevention.