about-banner

Are you an FDR?

Learn about HPSM's requirements, policies and procedures for a contracted First Tier, Downstream or Related Entity (FDR). 

 

Compliance Hotline

1-844-965-1241

The HPSM Compliance Program

The Health Plan of San Mateo is committed to conducting its business operations in compliance with ethical standards, contractual obligations, and all applicable state and federal statutes, regulations and rules, including those pertaining to Medicare, Medi-Cal and operations of health plans. HPSM’s compliance commitment extends to its business partners and delegated entities that enable HPSM to fully meet the needs of its members.

Jump to a section below

Our Commitment Reporting Compliance Issues Personal Injury & Third Party Liability FDR Program Enterprise Systems Catalog

Our Commitment

is to serve our members ethically

We’re committed to practicing business in an ethical manner. Our Compliance Program is designed to:

  • Assure compliance with all applicable federal and state laws governing HPSM
  • Assure compliance with contractual obligations
  • Detect violations of ethical standards
  • Combat fraud and abuse
  • Ensure effective education and training of staff and business partners

You can learn more about our commitment by reading about our Compliance Program and Code of Conduct.

Reporting Potential Compliance Issues

There are a number of ways to report suspected or detected non-compliance or potential fraud, waste and abuse. HPSM has established a confidential Compliance Hotline for HPSM employees, providers, members, FDRs, and other interested persons to report any violations or suspected violations of law and/or HPSM’s Compliance Program.

Compliance Officer

You can call HPSM’s Compliance Officer, Ian Johansson, during business hours to report compliance issues. HPSM’s business hours are 8:00 a.m. to 5:00 p.m., Monday through Friday (except holidays). To report an issue to Mr. Johansson, call  650-616-0050.

Compliance Hotline

The toll-free Compliance Hotline is 1-844-965-1241.

The Compliance Hotline is accessible 24 hours a day, 365 days a year, excluding designated holidays. Callers can report issues anonymously. All reports will be referred to HPSM’s Compliance Officer and investigated.

Compliance Incident Report

To place an anonymous report in confidence, the information you provide will be sent to us by EthicsPoint on a totally confidential and anonymous basis. You have our guarantee that your comments will be heard. Visit  EthicsPoint to make a new report or follow-up on a report you already submitted. 

Resources and Media

HPSM Policies

 
Civil Rights Obligations for Subcontractors (70 KB)
 
Compliance Hotline Communication Policy (48 KB)
 
Delegation Monitoring and Auditing (87 KB)
 
Delegation Oversight Activities and Responsibilities (63 KB)
 
Delegation Oversight Subcommittee and Charter (67 KB)
 
HPSM Compliance Program (270 KB)
 
Investigating and Reporting Fraud, Waste, Abuse and Neglect (68 KB)
 
Non-Intimidation and Non-Retaliation Policy (54 KB)
 
Notification Process for Compliance Issues (60 KB)
 
Oversight Responsibilities for Medi-Cal Delegates (93 KB)
 
Oversight Responsibilities for Medicare Delegates (FDR) (75 KB)
 
Policy on Reporting Compliance Concerns (67 KB)

Wall Posters

Download and print these 11x17 posters:

Personal Injury & Third Party Liability

Information for Lawyers/Representatives

  • Inquiries on behalf of HPSM Medi-Cal Members - please read the Personal Injury and Third Party Liability Information Brief
  • Inquiries on behalf of CareAdvantage, HealthWorx or Healthy Kids Members - please call Julie Mabana, HPSM TPL/COB Specialist at 650-616-0050
  • Inquiries on behalf of San Mateo County ACE Participants - please contact the Finance Office of the San Mateo Medical Center. Contact Melby Portillo: mportillo@smcgov.org or Patty Ruiz pruiz@smcgov.org or call 650-573-2525