At HMSA, we seek relationships with vendors who share our commitment to improving the well-being of Hawaii’s communities. We appreciate our partnerships with vendors for their shared commitment to building a sustainable health care system. With your help, we’re making strides toward a happier, healthier Hawaii.

Refer to the information provided in this article to learn about your obligations as an HMSA vendor and find resources to help answer policy or compliance questions you may have.

All HMSA vendors should review the Vendor’s Quick Guide to Compliance [PDF], particularly vendors contracted to perform administrative or health care services for our Medicare, Medicaid, Affordable Care Act, and federal plans. The document outlines key guidelines and policies you must adhere to during your relationship with HMSA. The guide also provides more detailed information on the items described below.

Vendor code of business conduct

HMSA conducts business in compliance with all applicable laws, rules, and regulations. We expect the vendors we work with to follow our standards of conduct as outlined in the HMSA Code of Business Conduct [PDF]. Vendors may also use their own code if it complies with HMSA’s code.

If you still have questions after you read the code, call your HMSA vendor contact or HMSA’s Compliance & Ethics Office.

Fraud, waste, and abuse training

All HMSA delegates supporting Medicare, Medicaid, and FEHBP programs must complete HMSA’s Fraud, Waste, and Abuse (FWA) training within 90 days and annually thereafter to ensure compliance with federal and state regulatory requirements.

To meet this requirement, you may have your employees complete your company’s FWA training or use HMSA’s FWA training [PDF].

Please document your training and retain the documentation for 10 years. Documentation should include training logs, reports, names, dates of employment, dates of completion, and passing scores for assessments if captured.

Compliance policies and reporting

HMSA promotes open communication between our employees, managers, directors, contractors, agents, and vendors and encourages everyone to ask questions, report problems, and share concerns.

HMSA prohibits intimidation or retaliation against anyone who reports actual, suspected, or potential compliance and ethics issues in good faith.

Do you need to report noncompliance, including health care fraud, waste, or abuse, to HMSA?

Contact HMSA’s Compliance officer at:

Mail:
HMSA Compliance & Ethics Office
P.O. Box 860
Honolulu, HI  96808-0860

Email:
Compliance_Ethics@hmsa.com

Call our anonymous compliance hotline:
1-800-749-4672 (HMSA)

Call our anonymous fraud hotline:
808-948-5156

Exclusion screening

Current or potential employees, managers, contractors, major shareholders, volunteers, owners, and agents who are on the following exclusion lists cannot perform any work related to the administration or delivery of federal and/or state plan benefits:

• Department of Health and Human Services Office of the Inspector General (OIG) List of Excluded Individuals and Entities
• General Services Administration System of Award Management (SAM.gov) for exclusions at the federal level.
• The Hawaii Med-QUEST Division’s Provider Exclusion/Reinstatement List.
• Office of Personnel Management Inspector General (OPM-OIG). If you're processing claims, HMSA provides this list to you.

You must review these lists:

• Before hiring or contracting individuals who will administer or deliver federal and/or state benefits.
• Every month to ensure that your employees, managers, and contractors who administer or deliver federal and/or state plan benefits aren’t excluded from participating in federal health care programs.

For a list of FAQs about exclusions, visit oig.hhs.gov, oig.opm.gov, or medquest.hawaii.gov/.