Compliance Program

Medicare Advantage Compliance

Harvard Pilgrim has implemented a comprehensive Medicare Compliance Program designed to ensure compliance with applicable laws, rules and regulations; help reduce or eliminate fraud, waste, and abuse; and reinforce our commitment to compliance. Our Medicare Compliance Program addresses important topics such as: standards of conduct and compliance policies and procedures; compliance officer and compliance committee; training and education; monitoring and auditing; how to report compliance issues, and how we look into and resolve compliance issues.

The documents and links below provide a summary of Harvard Pilgrim’s Medicare Compliance Program and to assist you, your organization, and any downstream entity for which you contract in complying with CMS requirements and Harvard Pilgrim policies. Thank you for your partnership with Harvard Pilgrim to help us provide exceptional service to our Medicare members.

For monitoring and auditing purposes, Harvard Pilgrim or CMS may request that you provide evidence of your compliance with any of the referenced requirements. And, Harvard Pilgrim may require corrective action if you fail to comply with either Medicare Program or Harvard Pilgrim’s Compliance Program requirements.