Compliance Program

Banner – University Health Plans (B – UHP) is committed to ethical and legal conduct. This includes meeting the obligations of a programs involving the delivery of health care services. B – UHP is a Medicare and Medicaid participant.

A key component of our commitment to meeting our obligations under these governmental programs and contractual relationships includes adopting standards that uphold these principles, which is the basis for this Compliance Program. The Compliance Program is described in several documents including the Code of Conduct, policies and procedures, as well as the Fraud, Waste, and Abuse Plan.

All employees and the Governing Bodies as well as first tier, downstream and related entities, subcontractors, Providers and agents (Business Partners) must make a personal commitment to adhere to the Code of Conduct.Please review our Compliance Program and Fraud, Waste and Abuse Plan (January 1st through December 31st), which includes the B – UHP code of conduct.

Banner – University Health Plans is committed to compliance and meeting requirements of all applicable laws and regulations of CMS and AHCCCS. As part of our compliance program, please review the FDR Guide to help ensure your compliance with CMS, AHCCCS, and B – UHP requirements.

Related Documents

2020 Compliance Program and Fraud, Waste and Abuse Plan

2020 FDR Guide

Annual Attestation and Disclosure Statement

Contracted providers and Subcontractors, with Banner – University Health Plans (B – UHP) are required to complete the Annual Attestation and Disclosure Statement.

Instructions:

1. Review each section

Section 1: Medicare and Medicaid Participation Compliance Program Requirements
Section 2: Attestations
Section 3: Organization Information and Signature

2. Complete the 2020 Annual Attestation online here: https://eservices.uph.org

*If you are unable to complete the online form above, below is the PDF version.

2020 Annual Attestation Form

3. Complete the Offshore Subcontracting Attestation if contracting with offshore entity.

2020 Offshore Subcontracting Attestation

Required Trainings

B – UHP General Compliance and FWA training is now available on our website. FDRs can take our training or a comparable training. FDRs are required to complete an attestation and submit it to B – UHP indicating that the employees involved in the administration of Medicare Part C and D benefits have satisfied the training requirement. For FDRs (Subcontractors) under the Medicaid line of business, the following are required training elements:

a. Detailed information about the Federal False Claims Act,

b. The administrative remedies for false claims and statements,

c. Any State laws relating to civil or criminal liability or penalties for false claims and statements, and

d. The whistleblower protections under such laws.

Documentation of internal training can be through an individual certificate or a list showing the information for all of those who completed it through the internal web-based training.

The Compliance Departments or Vendor Oversight Staff track completion of training by FDRs through the completion and collection of annual attestations from all FDRs.

2020 General Compliance Training for FDRs

Code of Conduct

The Code of Conduct states B – UHP’s over-arching principles and standards by which B – UHP operates and defines the underlying framework for the compliance policies and procedures. Staff, Providers, and Business Partners, from the top to the bottom of B – UHP’s organization, have the responsibility to perform their duties in an ethical manner in compliance with laws, regulations and B – UHP’s policies.

B – UHP requires that all FDRs supporting the Medicare Advantage and Part D Prescription Drug Program adopt and abide by the B – UHP Code of Conduct or implement a Code of Conduct that incorporates standards of conduct and requirements consistent with B – UHP’s Code of Conduct.

All B – UHP Staff and Business Partners must read the Code of Conduct annually and sign an acknowledgement that they agree to abide by the Code of Conduct.

Compliance Department Contacts

Contact our Compliance Department with any questions and/or to report potential compliance issues and fraud, waste, and abuse.

ComplyLine (Confidential and Anonymous):

(888) 747-7989 (24 hours a day/7 days a week)

Email:

BUHPCompliance@bannerhealth.com

Mail:

Banner – University Health Plans
Compliance & Audit Department
2701 E. Elvira Road
Tucson, AZ 85756

Fax:

(520) 874-7072

Compliance Officers:

Terri (Theresa) Dorazio, MS, CHC, CHPC, CPC
Director of Compliance
B – UHP Medicaid Compliance Officer
(520) 874-2847

Linda Steward, CHC
Compliance Program Director
B – UHP Medicare Compliance Officer
(520) 874-2553

Fraud, Waste, & Abuse

B – UHP is committed to preventing Fraud, Waste, and Abuse (FWA).

If you suspect a provider or member of fraud and abuse, please contact us at any of the following methods:

Phone

Customer Care Center: (877) 874-3930; TTY users call 711.
Confidential and Anonymous Compliance (ComplyLine) Hotline: (888) 747-7989; 24 hours a day/7 days a week.

Mail

Banner – University Health Plans
Compliance and Audit Department
2701 E. Elvira Road
Tucson, AZ 85756

Fax

(520) 874-7072

Email

BUHPCompliance@bannerhealth.com

Form

Report Fraud, Waste, and Abuse Form

You can also report directly to AHCCCS, Office of the Inspector General at:

Provider Fraud:(602) 417-4045 or (888) 487-6686
Member Fraud:(602) 417-4793 or (888) 487-6686
www.azahcccs.gov - click on "Fraud and Abuse"
Mail: Inspector General
701 E. Jefferson Street MD 4500,
Phoenix, AZ 85034

Examples of Fraud, Waste, and Abuse

Member Fraud, Waste, and Abuse include, but are not limited to:

Lending or selling your AHCCCS Identification Card to anyone.
Using someone else's AHCCCS card to obtain services.
Changing prescriptions written by any B – UFC/ACC provider.
Not stating true income or living arrangements.
Providing false materials or documents.
Leaving out important information.
Failing to report another insurance that you have.
Continuing to use AHCCCS for services when you move out of the state or out of the country.

Provider Fraud, Waste, and Abuse include, but are not limited to:

Ordering tests, lab work, or x-rays that aren't needed.
Charging for medical services not provided.
Billing multiple payers and receiving double payments.
Using billing codes that pay higher rates to get more money even though those services weren't provided.
Billing for services under a member who is not their member.
Providing unnecessary medical services leading to unnecessary costs to the program.
Use of the Medicaid system by someone who is unqualified, unlicensed, or has lost their license.

Provider Audits and Trends

The Banner – University Health Plans (B – UHP) Compliance Department has been conducting routine provider medical record audits through random selection. These audits are required by AHCCCS but apply to all lines of business. This audit compares medical record documentation to the claims submitted and paid by B – UHP to ensure both are proper and accurate.

The Auditors have identified similar errors in multiple audits and some of the types of errors observed include the following:

The Top Four Commonly Seen Errors:

Progress notes not signed appropriately – progress notes are required to be signed and dated by the rendering/treating provider after each appointment and/or procedure prior to being billed. What we see are notes that say pending; notes that are signed up to a year later; notes that are signed by someone on behalf of the provider or notes with no signature or date. These examples make the note invalid.
Services billed under the NPI of a provider who did not render the service for an AHCCCS service. For AHCCCS, providers are required to bill the claim under the NPI of the provider who rendered the service. Incident-to-services that are allowed under Medicare for Mid-levels to bill under a supervising physician is not allowed under AHCCCS. The PA and NP must be registered with AHCCCS and credentialed. If it is not billed under the rendering provider, the claim is null and void.
Upcoding of Evaluation and Management Services – Coding Guidelines require medical documentation to support the proper evaluation and management code billed. What we see in practice, is that the provider’s progress note does not support the level of service billed. Frequently, we are hearing that providers are using auto-fill and auto-prompts to facilitate and improve documentation, coding and billing. If used inappropriately, these tools can suggest a higher billing code than the actual services furnished warrant.
Diagnoses Codes Present on the Assessment And Not Billed – Many times the provider utilizes diagnoses codes in their assessment and these codes are not billed on the claim. The diagnoses codes on the progress notes should be utilized for billing.

If you have any questions regarding the errors and trends, please contact us by email at: BUHPCompliance@Bannerhealth.com.

Policies

B – UHP has written policies in place to:

Articulate our commitment to comply with all applicable Federal and State standards;
Describe compliance expectations as embodied in the Standards of Conduct;
Implement the operations of the Compliance Program;
Provide guidance to Staff and Business Partners on dealing with suspected, detected or reported compliance issues;
Identify how to communicate compliance issues to appropriate compliance personnel;
Describe how suspected, detected or reported compliance issues are investigated and resolved by our company; and
Include a policy of non-intimidation and non-retaliation for good faith participating in the Compliance Program, including, but not limited to reporting potential issues, investigating issues, conducting self-evaluations, audits and remedial actions, and reporting to appropriate officials

FDR Newsletters & Memos

B – UHP provides our network providers with our FDR quarterly newsletters and memos as necessary. Providers can find helpful information and updates about our compliance program and policies.