This section outlines regulatory compliance program requirements for Medicaid.
As part of our Compliance & Ethics program, UnitedHealth Group has adopted an enterprisewide Code of Conduct detailing the organization’s commitment to acting with integrity.
For Medicaid programs, the Deficit Reduction Act of 2005 requires established written policies and procedures to support fraud, waste and abuse (FWA) prevention efforts for employees and subcontractors, including requiring delegates to distribute to their employees either the delegate’s code of conduct or the UnitedHealth Group Code of Conduct.
The Code of Conduct can be shared with the delegated entity as a resource detailing key compliance policies and procedures.
Find the UnitedHealth Group Code of Conduct in the Standards of Conduct section.
Confidential reports can be made to UnitedHealth Group’s Vendor Fraud Hotline: 877-401-9430
For Medicaid, delegates must demonstrate awareness of program or state-specific FWA regulations and training on policies developed for FWA prevention efforts.
FWA Prevention Efforts Training
For Medicaid, as an alternative to the CMS training, delegates can provide proof of training by distribution of training materials or policies that provide detailed information on:
Find more information on Fraud, Waste & Abuse and Compliance.
Notification is required for excluded individuals or entities. UnitedHealth Group Compliance & Ethics Help Center: 800-455-4521
*Delegated entities are required to review all employees, providers and subcontractors -- including those individuals identified in the Disclosure of Ownership and Control Interest Statements -- against the exclusion lists.
Find more information on Exclusion Checks.
Delegates must retain records for 10 years to show compliance with requirements.
Find more information on Document Retention.
Find more information on Downstream Delegates.