Compliance Information

CalOptima Health’s Commitment to Compliance

General Information

CalOptima Health’s Compliance Program

CalOptima Health is committed to upholding the highest ethical standards. We comply with applicable laws, regulations and health care program requirements as well as CalOptima Health’s Code of Conduct, policies and requirements. CalOptima Health’s Compliance Program applies to our four programs: Medi-Cal, OneCare, OneCare Connect and Program of All-Inclusive Care for the Elderly.

CalOptima Health’s Compliance Program incorporates all the elements of an effective compliance program as recommended by the Office of the Inspector General and required by the Centers for Medicare & Medicaid. The Compliance Program is continually evolving and may be modified and enhanced based on compliance monitoring and identification of new areas of operational, regulatory or legal risk. CalOptima Health requires that its Board members, employees, and First Tier, Downstream and Related Entities (FDRs) conduct themselves in accordance with the requirements of CalOptima Health’s Compliance Program as well as CalOptima Health’s Code of Conduct.

If you see any activity that you think is fraudulent or wasteful, we strongly encourage you to call our Compliance and Ethics Hotline at 1-855-507-1805 or report the activity using the form below. You do not have to give your name to report the activity.

Report Compliance, Fraud or Abuse Issues Call our Compliance and Ethics Hotline at 1-855-507-1805 (TTY 711) or report the activity using our Compliance and FWA Reporting Form. The confidential form has instructions on how to fill it out and where to send it. You do not have to give your name to report fraudulent activity.

First Tier, Downstream and Related Entities Learn about compliance for CalOptima Health contracted entities.

Compliance Resource Links View resource documents, training and educational tools.

Terms and Conditions  View CalOptima Health’s standard terms and conditions. The terms and conditions printed, written and/or typed on the front and back of the purchase order are important to our Purchasing department.

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