Compliance Program

At USFHP, we are dedicated to our comprehensive Compliance and Code of Conduct Program.  Our main objective is adherence to TRICARE regulations, URAC standards, federal laws and conducting ourselves honestly and ethically in our daily operations.

Our Compliance Program is comprised of seven essential elements that foster a culture of compliance within the organization.

1. Policies, Procedures, and Standards of Conduct: establishing clear guidelines to direct processes, compliant behavior while maintaining ethical standards
2. Designation of a Compliance Officer and Compliance Committee: assigning responsibility for overseeing compliance activities and ensuring program effectiveness
3. Continuous Training and Education: providing ongoing education to staff to enhance understanding and adherence to our organization’s requirements
4. Effective Lines of Communication: ensuring open and accessible channels for reporting compliance issues and obtaining guidance
5. Internal Auditing and Monitoring: maintaining oversight and conducting regular audits to assess compliance with policies and procedures and defined regulations
6. Enforcement of Standards through Well-Publicized Disciplinary Guidelines: implementing and communicating disciplinary measures to address non-compliance
7. Response and Prevention: developing procedures for responding to compliance issues and taking proactive steps to prevent recurrence, including revising policies and practices as needed.

All staff members are educated on the Compliance Program and are required to comply with our Code of Conduct. The Code of Conduct includes guidelines on ethical behavior, compliance with laws, protection of confidential information, cybersecurity precautions and standards for professional conduct.  This commitment allows us to deliver superior health care services to our members and ensures that all healthcare partners are thoroughly educated on our company standards.  By adhering to the Code of Conduct, we support our mission and values which highlight compassion, respect, and excellence to member care.

Our goal is to deliver the best healthcare services to all our members in a way that guarantees compliance on every aspect of that service including provider credentialing, claim payment, privacy protections, customer service and all services provided by USFHP.

At USFHP, we maintain a strict no-retaliation policy to foster an environment where staff and members feel safe and empowered to report any concerns regarding compliance, ethical conduct, potential violations of fraud, waste, and abuse and the protection of PHI (protected health information).  This policy ensures that all reports are taken seriously and investigated thoroughly, without fear of reprisal for the reporting individual. By encouraging open communication and vigilance, we reinforce our commitment to maintaining the highest standards of integrity, safeguarding PHI and ensuring compliant practices across all aspects of our organization.

We encourage all staff, members, healthcare partners and business associates to utilize our compliance resources and contact information provided below to report any concerns or seek guidance on compliance matters.