Medicare compliance information

Why Medicare compliance matters to our members

Regence offers Medicare Advantage and Part D Prescription Drug plans. This means that Regence partners with the Centers for Medicare and Medicaid Services (CMS), the US Federal agency that administers Medicare, to provide Medicare benefits to our Medicare beneficiaries. We are obligated to follow CMS' rules for the Medicare program and ensure that our beneficiaries get the benefits that they are entitled to. This is called Medicare compliance.

Medicare compliance at Regence

Regence has a Medicare compliance department led by the Medicare compliance officer that works very hard to prevent, detect and correct non-compliance with Medicare rules. If you have a question or concern, you may contact the department anonymously at (877) 878-2273.

Activities of the Medicare Compliance department

The department conducts many activities to ensure that Regence is in compliance with Medicare rules, such as:

  • Providing Medicare compliance training and education to Regence employees, board members, contractors and vendors, such as health care providers.
  • Investigating reports of possible noncompliance with Medicare rules and ensuring that any noncompliant activities are corrected.
  • Monitoring and auditing areas that may be at risk for noncompliance.

Examples of noncompliance

Anytime Regence does not perform on its promises made to Medicare beneficiaries in the Evidence of Coverage, or any time an agent markets a plan to you in a way that violates the marketing rules, Regence is not complying with Medicare rules. Many times, noncompliance is unintentional - it may be the result of a computer issue that needs to be fixed. Intentional or not, the department is responsible for identifying and correcting the noncompliance. While the department, as well as Regence as a whole, tries hard to prevent noncompliance, Regence wants to identify and address problems as soon as possible. Members are valuable reporters of non-compliance and help us to identify and respond quickly.

If you have a Medicare Compliance concern, please call (877) 878-2273.