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What SI PPS staff and providers need to know!

The mission of the Compliance Office is to prevent, detect, and resolve conduct issues and non-compliance to laws and program requirements. This is necessary for us to uphold our reputation for honesty and integrity in our business and medical commitments.

Compliance guidelines can be found in the Code of Conduct, Compliance Manual, SI PPS Compliance Help Line, and Compliance policies and procedures.

The Code of Conduct is the basis of our Compliance Program. It outlines the duties and responsibilities of the program and of those who are associated with SI PPS.

The Compliance Manual contains policies and procedures and the standards of conduct that all persons and entities that participate or do business with SI PPS, including but not limited to (i) SI PPS and its employees, independent contractors, vendors, agents, suppliers, executives and governing body members (“PPS Associates”); and (ii) Participating Providers and their employees, independent contractors, vendors, agents, suppliers, executives and governing body members are expected to follow related to participation, conduct or activities that affect SI PPS’ operations or the DSRIP program.

SI PPS HelpLine

The Compliance Office is here to assist you to understand what compliance and ethical conduct means to SI PPS. If you are unsure about conduct in a certain situation, or believe that any standards of conduct may have been violated, please contact the Compliance Office. Ways to contact:

You can report anonymously or identify yourself. We will respond to your concerns as soon as possible.

Compliance policies and procedures provide the necessary guidance for employees and Participating Providers on compliance issues.

Compliance Policy 501: Designation and Responsibilities of the SI-PPS Compliance Officer

Compliance Policy 502: Creation and Responsibilities of the Compliance Committee

Compliance Policy 503: Retention of Records

Compliance Policy 504: Conflicts of Interest and Recusal

Compliance Policy 505: Compliance Training and Education

Compliance Policy 506: Exclusion Screening (revised title)

Compliance Policy 507: Risk Assessment

Compliance Policy 508: Effective Lines of Communication and Internal Reporting of Compliance-Related Matters

Compliance Policy 509: Responding to Compliance Reports, Investigations, and Corrective Action

Compliance Policy 510: Responding to a Search Warrant or Governmental Subpoena

Compliance Policy 511: Identification and Return of Medicaid Overpayments

Compliance Policy 512: Discipline and Corrective Action

Compliance Policy 513: Non-Intimidation and Non-Retaliation

Compliance Policy 514: Detecting and Preventing Fraud, Waste and Abuse and Misconduct

Compliance Policy 515: Compliance Program

Compliance Policy 516: Antitrust Policy

Compliance Policy 517: Performance Measures and Corrective Action Plans

Introduction for Providers:

Participating Provider Obligations

All Participating Providers need to inform SI PPS of information concerning any identified compliance issues. Specifically issues that affect DSRIP funds or arising under any laws, rules, regulations, standards, guidelines, policies and procedures relating to DSRIP. Report this information to the SI PPS Compliance Officer. All Participating Providers should work together with SI PPS and its representatives to address and remediate any identified compliance issues. Upon request, providers will give SI PPS, and its representatives, reasonable access to their operations for this purpose.

All Participating Providers will act in good faith to comply with all federal, State and local laws, rules, and regulations and all rules, standards, guidelines, policies, and procedures of DOH relating to the DSRIP program. This includes but is not limited to implementing as effective compliance program as may be required by law.