Skip to Main Content

Prevent & Report Fraud, Waste & Abuse

Find out how to identify fraud, waste or abuse and how to report it. Get answers to your frequently asked questions.

We Are Committed to Sustaining a Culture of Integrity & Compliance

Our Corporate Integrity Program is our commitment to comply with laws and regulations relating to health care operations. The Program was designed to assist in the prevention and detection of violations of law and to promote the highest standard of professional ethics in delivery of health care services and education for everyone. The Program furthers our Mission, Vision and Values and assists in preventing compliance issues.

Samaritan Health Plans and InterCommunity Health Plans, as recipients of federal funds, state funds, and funds from contracted entities for identified services, have a responsibility to ensure the integrity of our programs for our members.

We have joined together with our network of healthcare providers to deliver innovative medicine and world-class quality of care in a way that is consistent with the values of the communities we serve, while building and sustaining a strong culture of integrity and compliance.

We strive to ensure compliance with federal, state and local laws and regulations that apply to the health insurance industry and to each contract. We are committed to comprehensive compliance with contractual, legal, and ethical expectations.

Our policies and procedures reflect the organization’s goal to meet or exceed compliance standards. Our Compliance Plan is organized according to the guidance found in 42 CFR 422.504 and 42 CFR 423.504 and complies with CMS’ program requirements. The Plan includes measures that prevent, detect, and correct fraud, waste, and abuse. It was updated and approved by the Compliance Committee in January 2016.

Our Compliance Plan provides support to our healthcare, insurance and educational operations. This plan is intended to provide reasonable assurance to our members and communities of the Mid-Willamette Valley and Central Oregon Coast that we:

  • Establish, monitor, and support high professional and ethical standards.
  • Support initial and continuing compliance education and training.
  • Comply with federal, state and local laws and regulations that are applicable in our daily operations.
  • Satisfy the conditions of participation in health care programs funded by the federal and state governments.
  • Promote self-monitoring and provide for, in appropriate circumstances, voluntary disclosure of violations of laws and regulations.
  • Review, investigate, and respond to allegations of violations and misconduct.
  • Provide no retaliation to anyone who, in good faith, reports a violation of our policies, contractual obligations or law.

Resources

How to identify waste, fraud and abuse

What you should do if you suspect fraud, waste or abuse

Compliance Program

Confidential and Proprietary Information 

Conflict of Interest Policy

Fraud, Waste and Abuse Program 

Disciplinary Standards

Special Investigation Form