Corrective Action Plans Support Compliance with Fraud Waste and Abuse Requirements
Corrective Action Plans
Highmark Wholecare’s Financial Investigations and Provider Reviews (FIPR) team conducts audits regarding fraud waste and abuse (FWA) to ensure our members receive cost-effective and sustainable services. If an audit identifies errors, providers will need to complete corrective actions, including a Corrective Action Plan (CAP), to address areas of noncompliance and resolve the deficiencies. An effective CAP will:
- Specify steps to remediate the underlying problem, including identifying time frames of implementation and staff members who are responsible for changes.
- Improve processes so that outcomes are more effective and efficient.
- Include methods to monitor the effectiveness of these changes.
CAPs should be submitted within 30 days of the request date and should be reviewed and acknowledged by a Notarial Official. Subsequent FWA audits may be performed to measure CAP adherence.
Call the FWA hotline at 844-718-6400.