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FIVE THINGS PROVIDERS NEED TO KNOW ABOUT THE Extended MLTC COMPLIANCE PROGRAM

At Extended MLTC, we are committed to preventing and detecting any fraud, waste or abuse in the organization related to federal and state health care programs. Here are five things that you, as a provider, should know about the Extended MLTC Compliance Program.

1. What is a Compliance Program?

A Compliance Program is a series of internal controls and measures that have been established to ensure that we are following all applicable laws and regulations that govern the program in which we participate.

At Extended MLTC, we endeavor to promote a work environment that fosters an atmosphere of non intimidation and ensures protection from retaliation for good faith participation in our compliance program. We have systems in place to receive, document and respond to compliance questions, or reports of potential or actual non-compliance from employees, contractors, agents and directors, while maintaining confidentiality and ensuring non-retaliation against callers.

2. What are the rules you must follow?

The standards set forth in the Code of Ethical Behavior provide an overview of the laws and rules our employees and providers are expected to follow. A copy of the Code of Ethical Behavior is provided to all of our employees upon hire, and is available to providers when they join the network, is available on our intranet and website or upon request from the Compliance Officer. We expect everyone connected to Extended MLTC to conduct themselves pursuant to the highest ethical, business and legal standards. If you suspect anything that is being done as part of the care or services you are providing to one of our members might be illegal or unethical, please report it to the Compliance Officer immediately.

3. What kind of things should be reported?
  • Questionable billing, coding or medical record documentation
  • Giving or accepting something of value in exchange for patient referrals or other business
  • Quality of care issues
  • Altering medical or business records
  • Assisting or ignoring fraud, waste or abuse concerns and/or any activity or business practice that could possibly be interpreted as unethical or illegal
4. What should I do if I suspect compliance violation?

If you suspect insurance fraud, abuse or suspicious activity, such as it is described above, has occurred, is occurring or will occur, please report it immediately though any of the following channels:

  • Email Extended MLTC Compliance at compliance@extendedmltc.org
  • Call the Compliance Hotline at 1-212-356-2935
  • Send a written report to:
Extended MLTC
Compliance Officer
21 Penn Plaza
360 West 31st Street, Suite 304
New York, NY 10001
5) Can I raise the issue anonymously?

Yes. All reported compliance issues will be investigated. Be assured, there will be no intimidation of, or retaliation against, anyone who in good faith raises a compliance issue.