In our commitment to prevent fraud and abuse, MCNA has implemented a program integrity component of our Compliance Program. We monitor and maintain integrity by implementing the following activities:

• Duplicate payment prevention
• Post-payment utilization review to detect fraud and abuse
• Internal controls to ensure payments are not issued to providers that are excluded or sanctioned under Medicare/Medicaid
• Review of alleged illegal, unethical, or unprofessional behavior
• Provider profiling to identify over or underutilization of services
• Investigations and audits

All program integrity activities are coordinated with MCNA's Special Investigations Unit.

Our providers are expected to bill only for medically necessary services delivered to members in accordance with MCNA's policies and procedures. MCNA and the appropriate governmental agencies actively investigate all suspected cases of fraud and abuse. We encourage you to ensure that all staff members are aware of MCNA's fraud reporting policies and procedures and their role in the process.

Please refer to these great toolkits for providers by the Centers for Medicare & Medicaid Services for more information about identifying and helping to prevent fraud.