Compliance is Everyone’s Responsibility!
According to federal and state regulations, a health plan such as AgeWell New York must implement a compliance program that is effective in preventing, detecting and correcting non-compliance and Fraud, Waste and Abuse.
If you suspect a compliance violation or a case of Fraud, Waste or Abuse, call the toll-free confidential Compliance Hotline at 1-888-336-7240, 24 hours per day, 7 days per week.
Below are key compliance program documents and links for your reference and training purposes. Please contact the corporate compliance department with any issues or concerns.
Standards of Conduct
AgeWell New York is fully committed to operating a health plan that meets the requirements of all applicable federal and state laws, regulations and guidelines. If you interface with any health care lines of business, such as Medicare and Medicaid, the AgeWell New York Compliance Program Standards of Conduct apply to you.
The Standards of Conduct articulate AgeWell New York’s culture of compliance and ethical behavior. We expect and require that all members of the AgeWell New York community abide by the highest standards of integrity, including providers and First-Tier, Downstream and Related entities (FDRs).
Training for Medicaid Providers and First Tier, Downstream and Related Entities
Plan sponsors must ensure that general compliance and Fraud, Waste and Abuse training is provided to all Medicaid providers and First-Tier, Downstream and Related Entities.
First-Tier, Downstream and Related Entities (FDRs) are parties to which AgeWell New York has delegated administrative, health care service or management functions relating to AgeWell New York’s Medicare Advantage Prescription Drug Plan’s contract with the Centers for Medicare and Medicaid Services (CMS).
Starting January 1, 2016, to comply with compliance training requirements, AgeWell New York must accept from FDRs, certificates of completion of CMS training located on the Medicare Learning Network (MLN). AgeWell New York will accept either the MLN system-generated certificates of completion or an attestation confirming that the organization has completed the appropriate compliance and FWA training.
Provider and FDR Compliance and Fraud, Waste and Abuse Training Annual Attestation
AgeWell New York’s commitment to ethical business behavior includes ensuring that our contracted providers and First Tier, Downstream and Related Entities (FDRs) maintain compliance with all federal and state regulations, requirements and guidelines. Each contracted provider and FDR must complete the attestation to confirm compliance with AgeWell New York’s Corporate Compliance Program requirements.
The attestation must be completed by an authorized representative with signatory authority on behalf of your organization and returned electronically to AgeWell New York’s Corporate Compliance Department at Corporatecompliance@agewellnewyork.comcreate new email
Reporting Non-Compliance and Fraud, Waste and Abuse
If you suspect a case of non-compliance, Fraud, Waste or Abuse, or any other violation of law or AgeWell New York’s policies, you can report via any of the following means:
- Call AgeWell New York’s toll-free confidential Compliance Hotline 1-888-336-7240
- File a report via Corporatecompliance@agewellnewyork.comcreate new email
- Call the AgeWell New York Corporate Compliance Department 1-718-484-5032
- Write to the Corporate Compliance Department at AgeWell New York, LLC, 1991 Marcus Ave, Suite M107, Lake Success, NY 11042
- Call your point of contact person at AgeWell New York