UnitedHealth Group Delegated Entity Compliance Program

Code of Conduct & Distribution

Delegates must distribute written policies, procedures, or standards of conduct to employees and volunteers within 90 days of hire and/or contracting and annually thereafter, or when the Code of Conduct is updated.

UnitedHealth Group has adopted an enterprise-wide Code of Conduct detailing the organization’s commitment to acting ethically and with integrity. Delegates may reference the UnitedHealth Group Supplier Code of Conduct as a compliance resource.

FWA Program

Delegates working with our either QHPs, Medicare Advantage Parts C and D or Medicaid programs must develop and maintain a FWA program that includes written policies and procedures. Employees and volunteers should be provided FWA program training within 90 days of hire and annually thereafter, or when the FWA program is updated.

Need Support?

If you need assistance with your organization’s FWA training program, contact your account representative or click here.

Reporting suspected fraud

If you suspect FWA related to your contract, take action and click here.

All delegates working with our QHPs, Medicare Advantage Parts C and D or Medicaid programs must review the federal exclusion lists maintained by the U.S. Department of Health & Human Services – Office of the Inspector General (OIG) and the U.S. General Services Administration (GSA) prior to hiring or contracting with them, and on a monthly basis thereafter. These exclusion lists name individuals or organizations that are suspended or otherwise excluded from participation in federal programs.

Hiring or contracting employees

Employees are defined as hired staff, management and temporary workers for your company, or subcontractors that are involved in or have responsibility for a delegated core function in the administration or delivery of federal health plan benefits and have access to protected health information (PHI)/personal identifiable information (PII).

State Exclusion Checks

Many states maintain state-based sanction/exclusion databases that are in addition to, but do not replace, the OIG and GSA federal exclusion databases. A provider may not participate in the network of a specific state if the provider is listed on that state’s exclusion list, even if the provider is not listed on a federal exclusion list.

Delegates must maintain records for 10 years to demonstrate compliance with regulatory requirements, including standards of conduct education, FWA and general compliance training, OIG/GSA exclusion checks, and supporting policies and procedures. A delegate may be called upon by our organization or a regulatory agency to provide documentation upon request. Failure to comply may result in any of a series of regulatory enforcement actions and remediation activities.

Examples

• Communication of Standards/Code of Conduct in an email, website portal or contract.
• FWA and general compliance training methods, materials used for training, attestations or electronic certifications that include the date of the training.
• Method of OIG/GSA and state (if applicable) exclusion checks and a copy of a sanction check report for each employee/contractor.
• Policies and procedures that describe the processes used to meet the regulatory requirements.

Notification and approval requirements prior to moving services offshore or to new subcontractors:

• For Medicare it is required for any functions that involve beneficiary data (i.e., PII & PHI).
• For Medicaid it is required for all offshoring activities, as some states have requirements that require consideration.

Please review your contract for specifics and contact your UnitedHealth Group representative to initiate the review process towards gaining express written approval.

When using a subcontracted entity, delegates must ensure compliance or oversee corrective action when gaps are identified. For example, CMS and state regulators often require our organization to monitor and/or audit to confirm delegates’ compliance with the following:

• Medicare, Medicaid, and ACA regulations
• Sub-regulatory guidance
• Contractual agreements
• All applicable federal and state laws
• Internal policies and procedures to protect against noncompliance and potential FWA