438.608—Program integrity requirements.
(a) General requirement.
The MCO or PIHP must have administrative and management arrangements or procedures, including a mandatory compliance plan, that are designed to guard against fraud and abuse.
(1)
Written policies, procedures, and standards of conduct that articulate the organization's commitment to comply with all applicable Federal and State standards.
(2)
The designation of a compliance officer and a compliance committee that are accountable to senior management.
(4)
Effective lines of communication between the compliance officer and the organization's employees.
(7)
Provision for prompt response to detected offenses, and for development of corrective action initiatives relating to the MCO's or PIHP's contract.