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MetroPlus Health Plan (MetroPlusHealth) is committed to providing quality care and service. As such, it has partnered with various entities to assist with honoring its contracts with the Centers for Medicare and Medicaid Services (CMS) and the New York State Department of Health (DOH). Our contractual agreement with you has identified you as a first-tier entity who must comply with these requirements. As you may subcontract with others to assist in your agreement with MetroPlusHealth, those providers are our downstream entities. On an ongoing and annual basis, we are required to ensure that you, and our downstream entities, meet our compliance program requirements, as well as all contractual obligations.

Included in the annual compliance program are:

  • General compliance and fraud, waste, and abuse (FWA) training
  • Compliance policies and procedures, such as Code of Conduct
  • Office of Inspector General, General Services Administration, Office of Medicaid Inspector General exclusion, preclusion list and prohibited relationships screenings
  • Maintenance of sufficient information Privacy Protocols

Noncompliance with these and other requirements may result in the revocation of the delegated activities for which you are contracted.

Please refer to the enclosed information to assist you in meeting your obligations. We value your partnership and thank you for your commitment to providing the highest quality of care and services to our members!

If you have questions or concerns, please contact us at [email protected].

last updated: June 13, 2024

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