Colorado Access (COA) is committed to the highest levels of quality and ethical standards and to ensuring that all its business is conducted in compliance with Federal, State and local laws and within applicable regulatory guidelines.
Colorado Access maintains mechanisms to prevent, detect, investigate and correct incidents of Fraud, Waste and Abuse in accordance with contractual, regulatory and statutory requirements. Employees and contractors of COA shall be educated on false claims acts and the roles such laws play in preventing and detecting fraud, waste and abuse in governmental health care programs.
Colorado Access will take appropriate disciplinary action against employees, providers, subcontractors, consultants, and agents found to have violated COA policies or the Code of Conduct and/or committed Fraud, Waste or Abuse.
Fraud, Waste and Abuse
As part of the Colorado Access compliance program, we have an obligation to report known or suspected fraud, waste and abuse. We use the terms "fraud", "waste" and "abuse" defined below as applied to our business.
Fraud An intentional deception or misrepresentation made by a person with the knowledge that the deception could result in some unauthorized benefit to him/herself or some other person.
Abuse Practices that are inconsistent with sound fiscal, business or medical practices, and that result in an unnecessary cost to government programs, or in seeking reimbursement for goods or services that are not medically necessary or that fail to meet professionally recognized standards for healthcare. It also includes member practices that result in unnecessary cost to Medicaid programs.
Waste Incurring unnecessary costs as a result of deficient management, practices, systems or controls; the over-utilization of services (not caused by criminally negligent actions) and the misuse of resources.
Some examples of fraud include billing for services not ordered or provided, providing false information about membership or eligibility, providing false information about credentials or certifications, and billing for services that were performed by an individual or entity that has been excluded from participation in government healthcare programs.
If you suspect fraud, waste or abuse, please contact us.
Report Compliance Issues
For good faith, anonymous reporting of any compliance concerns, including fraud, waste or abuse or other compliance-related matters, please call our Compliance Hotline toll free at 1-877-363-3065. You do not need to give your name.
Please click on the links below for additional information.