Compliance & integrity

Compliance & integrity

Samaritan Health Services (SHS) is a values-driven, church-related organization governed by community members, physicians and other health care providers that are committed to building our health services, education and insurance operations with integrity. SHS is a non-profit network of hospitals, physician clinics, health services, and managed care plans caring for the communities of the mid-Willamette valley and central Oregon coast.

The Corporate Integrity Program (Program) is our commitment to comply with laws and regulations relating to healthcare operations. The Program was designed to assist in the prevention and detection of violations of law and to promote the highest standard of professional ethics in delivery of health care services and education for everyone. The Program furthers the SHS Mission, Vision and Values and assists in preventing compliance issues.

Samaritan Health Plan Operations (SHPO), a division of SHS, is responsible for administering all insurance lines of business. SHPO is a quality-based, affordable health plan servicing Linn, Benton, and Lincoln County residents. As a recipient of federal funds, state funds, and funds from contracted entities for identified services, SHPO has a responsibility to ensure the integrity of its program for its members. We've joined together to provide innovative medicine and world-class quality of care in a way that’s consistent with the values of the communities we serve while building and sustaining a strong culture of integrity and compliance.

SHPO strives to ensure compliance with federal, state and local laws and regulations that apply to the health insurance industry and to each contract. SHPO is committed to comprehensive compliance with contractual, legal, and ethical expectations. SHPO policies and procedures reflect the organization’s goal to meet or exceed compliance standards.

This SHPO Compliance Plan is organized according to the guidance found in 42 CFR 422.504 and 42 CFR 423.50 and complies with CMS' program requirements. The Plan includes measures that prevent, detect, and correct fraud, waste, and abuse. The SHPO Compliance Plan was updated and approved by the Compliance Committee in December 2012.

Our Compliance Plan provides support to our healthcare, insurance and educational operations. This plan is intended to provide reasonable assurance to our members and communities of the Mid-Willamette Valley and Central Oregon Coast that SHPO: 
    
• Establishes, monitors, and supports high professional and ethical standards; 
• Supports initial and continuing compliance education and training; 
• Complies with federal, state and local laws and regulations that are applicable in our daily operations; 
• Satisfies the conditions of participation in health care programs funded by the federal and state governments; 
• Promotes self-monitoring and provides for, in appropriate circumstances, voluntary disclosure of violations of laws and regulations; 
• Reviews, investigates, and responds to allegations of violations and misconduct. 
• Provides no retaliation to anyone who, in good faith, reports a violation of SHPO Policies, contractual obligations or law.

Resources:
How to identify waste, fraud and abuse
What you should do if you suspect fraud, waste or abuse
2013 Compliance Program
Confidential and Proprietary Information
Identification of Network Fraud and Abuse
Conflict of Interest Policy
IHP Prevention and Detection of Fraud and Abuse
Fraud and Waste Abuse Program
Disciplinary Standards
Special Investigation Form