Health Plans Ethics and Compliance Program

Case Statement:

Team 2 has just been hired as the Consulting Director to the Board of a Health Plan that insures 30% of the residents in a metropolitan area of 500,000 population. Most of those insured by this health plan are insured by large companies in the metropolitan area, and those companies pay for their employees health insurance. The health plan Board wants a new Ethics and Compliance Program created. The goals are to meet the Federal Sentencing Guidelines for effective corporate compliance programs and to ensure that the Health Plan operates in a lawful manner.

Case Study Discussion:

In Team 2s new role, you are asked to recommend to the Board an effective Ethics and Compliance Program.

1. What stakeholders would you engage to create the Program?

2. What are the elements that must be included in an effective corporate compliance program?

3. What role will the board of the Health Plan serve in developing this Program?

4. How can top management be held accountable for accomplishing the Ethics and Compliance Program?

5. Explain what competencies Team 2 used in addressing the Team Case Presentation.