Program Integrity

Program Integrity & Corporate Compliance

Virginia Premier is committed to conducting all facets of its operations in compliance with applicable laws, regulations, policies and procedures. The foundation for that approach is a “zero tolerance” for fraud, waste and abuse in every aspect of our business.  Download our Code of Ethics.

Corporate Compliance Purpose

The purpose of the Corporate Compliance & Integrity Plan is to serve as a guide for officers, directors, employees and affiliated individuals to follow in conducting business with and/or on behalf of Virginia Premier. The benefits of this “Plan” are to establish a structure to:

  • Maintain operations in compliance with laws and regulations;
  • Provide information to Virginia Premier Board of Directors and Integrity & Compliance Committee on the status of organizational compliance;
  • Make legal and policy changes quickly in response to identified compliance needs;
  • Increase organizational wide vigilance of legal and regulatory requirements;
  • Respond appropriately to investigations, audits and other compliance issues that may arise; and
  • Decrease the likelihood of civil liability.

Standards of Professional Conduct

This policy specifically relates to the Corporate Compliance Plan Code of Conduct and other standards. All parties are expected to adhere and shall comply with the following:

  • Treat members with respect and dignity
  • Deal openly and honestly with fellow employees, members, providers, representatives, agents, government entities and others
  • Adhere to federal and state laws and regulations and Virginia Premier policies and procedures in all business and personal dealings whether at work or outside work
  • Exercise discretion in the processing of claims regardless of provider, practitioner and vendor source
  • Notify and return overpayments to the health plan immediately upon receipt of such payments
  • Notify the Corporate Compliance Officer of any instances of non-compliance and cooperate with all investigation efforts by Virginia Premier and other state and federal agencies
  • Use supplies and services in an efficient manner to reduce cost to the health plan
  • Misuse of Virginia Premier resources or influence in such a way as to discredit the reputation of Virginia Premier is prohibited
  • Maintain high standards of business and ethical conduct in accordance with regulatory and accredited agencies to include standards of business to address fraud, waste and abuse
  • Practice good faith in transactions occurring during the course of business
  • Conduct business dealings in a manner that the organization shall be the beneficiary of such dealings
  • Preserve patient confidentiality unless there is written permission to divulge information, except as required by law
  • Refuse any illegal offers, solicitation, payment or other remuneration to induce referrals of the members we serve for an item of service reimbursable by a third party
  • Disclose financial interests/affiliations with outside entities to Virginia Premier as required by the Conflict of Interest policy
  • Hold all contracted parties to the same Standards of Professional Conduct as part of their dealings with Virginia Premier
  • Notify the Program Integrity Officer of any instances of non-compliance and cooperate with all investigation efforts by Virginia Premier and state and federal agencies