Compliance

If you become aware of possible fraud, waste or abuse that relates to a Health Plan that SOMOS is contracted with (for example, you become aware of a medical provider submitting a claim where services were not rendered), contact the Health Plan Special Investigations Unit (SIU):

1. EmblemHealth’s SIU: (888) 456-3728

2. Empire HealthPlus’s SIU: (877) 725-2702

3. HealthFirst’s SIU: (877) 879-9137

If you have Compliance questions or become aware of a potential failure to be complaint with the laws, regulations, or SOMOS contracts, contact Dean Carilli, SOMOS Chief Compliance Officer, at (646) 306-0935 or send him an email at dcarilli@somosipa.com. If you are not certain if your concern is fraud, waste, abuse, or a compliance issue, contact Dean Carilli, and he will make certain the issue reaches the correct party or Health Plan. If you would prefer, you can submit your question anonymously through the EthicsPoint website or call the Hotline at (855) 233-3135.

Dean Carilli can also be contacted if you have specific questions regarding the handling of protected health information (PHI) or HIPAA Privacy and Security.

If you become aware of a privacy breach or an information security incident, please contact Dean Carilli and SOMOS Chief Information Officer, John Dionisio at jdionisio@somosipa.com, or you can submit your concern anonymously through the EthicsPoint website or call the Hotline at (855) 233-3135.

Compliance

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