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AlohaCare Compliance and Fraud, Waste, and Abuse Resources and Information for Business Partners

AlohaCare has a contract with CMS to provide Medicare Advantage Plans and a contract with the State of Hawaii to provide a Medicaid plan (QUEST).  As part of these contracts, AlohaCare is required to maintain an effective compliance program, which must include measures to prevent, detect and correct Medicare and QUEST program noncompliance as well as Fraud, Waste and Abuse (FWA).  A requirement of the compliance program is the oversight of our Business Partners (technically referred to as first tier, downstream, and related entities (FDR) for Medicare and providers and subcontractors for QUEST).

Example of AlohaCare Business Partners include, but are not limited to:

  • Healthcare Providers
  • Hospitals
  • Certain Vendors
  • Agents/Brokers
  • Certain Contractors and Consultants

Requirements for Business Partners

  • Perform monthly exclusion checks
  • Provide FWA and Compliance training
  • Maintain compliance and FWA training records
  • Maintain Standards of Conduct or use AlohaCare’s Business Conduct Guidelines
  • Refrain from providing gifts to AlohaCare employees
  • Disclose any Conflict of Interest
  • Report all potential misconducts to AlohaCare

We at AlohaCare are committed to our compliance program and we need the assistance of our Business Partners to reach our compliance program goals.  We encourage our Business Partners to utilize AlohaCare’s policies and procedures, training resources, and FWA information. On this page our Business Partners can find FWA resources, training information, AlohaCare Business Conduct Guidelines, Exclusion Check requirements, Conflict of Interest declaration, as well as information on how to report compliance issues.  If you require further assistance please contact AlohaCare’s Compliance department at 808-973-7486.