Quality and Compliance

Compliance

The Martin's Point Health Care Compliance Program applies to all Martin's Point employees and board members, including but not limited to those working in physician offices, insurance departments, vendors, and downstream entities. The program represents a set of practices and procedures that reflect the company’s commitment to do the right thing at the right time, and the implementation of effective management steps to ensure full compliance with applicable State and Federal laws, regulations, contracts, and other legal requirements that govern our organization. Our Compliance Program provides compliance as well as fraud, waste, and abuse oversight to our contracted, first tier, downstream, and related entities. All contracted providers and their staff are required to be familiar with the Martin's Point Health Care Compliance Program and code of ethics. All contracted providers and their staff are also required to complete fraud, waste and abuse training. For more information, please refer to the links below:

Compliance program and code of ethics

Medicare-approved fraud, waste and abuse training

Quality

The Martin’s Point Health Plan Quality Program (HPQ) delineates the structure, processes, and intent that Martin’s Point Health Care (MPHC) has put in place to ensure the highest quality of health care delivery. It provides a formal process to objectively and systematically monitor and evaluate the quality, appropriateness, efficiency, safety, and effectiveness of care and service utilizing a multidimensional approach. This approach enables MPHC to focus on opportunities for improving operational process as well as health outcomes and satisfaction of members and providers. It includes the monitoring and measurement processes for our US Family Health Plan and Generations Advantage members and our Delivery System patients through continuous process and quality improvement activities. HPQ promotes the accountability of all employees and affiliated health personnel for the quality of care and services provided to our members and patients.

Provider Manual - Quality