corporate compliance program

The purpose of Cigna-HealthSpring’s corporate compliance program is to articulate Cigna-HealthSpring’s commitment to compliance. It also serves to encourage our employees, contractors, and other interested parties to develop a better understanding of the laws and regulations that govern Cigna-HealthSpring’s operations. Furthermore, Cigna-HealthSpring’s corporate compliance program also ensures that all practices and programs are conducted in compliance with those applicable laws and regulations.

Cigna-HealthSpring and its subsidiaries are committed to full compliance with federal and state regulatory requirements applicable to our Medicare Advantage and Medicare Part D lines of business. Non- compliance with regulatory standards undermines Cigna-HealthSpring’s business reputation and credibility with the federal and state governments, subcontractors, pharmacies, providers, and most importantly, its customers. Cigna-HealthSpring and its employees are also committed to meeting all contractual obligations set forth in Cigna-HealthSpring’s contracts with the Centers for Medicare and Medicaid Services (CMS). These contracts allow Cigna-HealthSpring to offer Medicare Advantage and Medicare Part D products and services to Medicare beneficiaries.

The corporate compliance program is designed to prevent violations of federal and state laws governing Cigna-HealthSpring’s lines of business, including but not limited to, health care fraud and abuse laws. In the event such violations occur, the Corporate Compliance program will promote early and accurate detection, prompt resolution, and, when necessary, disclosure to the appropriate governmental authorities.

Cigna-HealthSpring has in place policies and procedures for coordinating and cooperating with MEDIC (Medicare Drug Integrity Contractor), CMS, state regulatory agencies, Congressional Offices, and law enforcement. Cigna-HealthSpring also has policies that delineate that Cigna-HealthSpring will cooperate with any audits conducted by CMS, MEDIC or law enforcement or their designees.

To report suspected or detected Medicare program non-compliance please contact Cigna-HealthSpring’s Compliance Department at:

Cigna-HealthSpring
Attn: Compliance Department
PO Box 20002
Nashville, TN 37202

To report potential fraud, waste, or abuse please contact Cigna-HealthSpring’s Benefit Integrity Unit at:

By mail:
Cigna-HealthSpring
Attn: Benefit Integrity Unit
500 Great Circle Road
Nashville, TN 37228

By phone:
1-800-230-6138
Monday through Friday, 8 a.m. to 6 p.m. CST

All such communications will be kept as confidential as possible but there may be times when the reporting individual’s identity may become known or need to be disclosed to meet requirements of any governmental review actions. Any employee, contractor, or other party that reports compliance concerns in good faith can do so without fear of retaliation.

In addition, as part of an ongoing effort to improve the delivery and affordability of health care to our customers, Cigna-HealthSpring conducts periodic analysis of all levels of Current Procedural Terminology (CPT), ICD-9 and HCPCS, codes billed by our providers. The analysis allows Cigna-HealthSpring to comply with its regulatory requirements for the prevention of fraud, waste, and abuse (FWA), and to supply our providers with useful information to meet their own compliance needs in this area. Cigna-HealthSpring will review your coding and may review medical records of providers who continue to show significant variance from their peers. Cigna-HealthSpring strives to ensure compliance and enhance the quality of claims data, a benefit to both Cigna-HealthSpring’s medical management efforts and our provider community. As a result, you may be contacted by Cigna-HealthSpring’s contracted partners to provide medical records to conduct reviews to substantiate coding and billing.

Steps to Meet Your FWA Obligations
Review and revise your coding policies and procedures for compliance and adherence to CMS guidelines necessary to ensure they are consistent with official coding standards.

Complete the mandatory online training at:

 

You may request a copy of the Cigna-HealthSpring Compliance program document by contacting your Cigna-HealthSpring Provider Relationship Representative.