Compliance Program

Compliance with applicable laws and regulations play a critical role in the Healthcare Industry. First Medical Health Plan, Inc. (First Medical) is committed to implementing a comprehensive and effective Compliance Program in compliance with federal and state laws and regulations applicable to the healthcare industry and the relevant and applicable requirements established by the Centers for Medicare & Medicaid Services (CMS), the U.S. Department of Health and Human Services, the Office of Inspector General (OIG), the Puerto Rico Health Insurance Administration (PRHIA), the Office of the Commissioner of Insurance of Puerto Rico (OCI), the Health Insurance Portability and Accountability Act (HIPAA), among others.

First Medical’s Compliance Program reflects our unwavering commitment to the highest standards of corporate conduct and integrity. We believe that compliance efforts are designed primarily to establish a culture within the organization that promotes the prevention, detection and resolution of conduct cases that do not comply with federal and state laws, or the requirements of the Federal Health Care Program. The primary objective of the First Medical’s Compliance Program is to ensure compliance with all Healthcare Industry requirements, identify risk areas, prevent fraud, waste, and abuse, eradicate unethical conduct, and optimize operational functions, improving the quality of health services. First Medical strives to promote a culture of compliance that harmonizes with our day-to-day business operations and the trust of Vital Plan beneficiaries.

If you need a copy of the Compliance Program, please feel free to contact First Medical’s Customer Service Department at 1-844-347-7800; TTY/TDD users should call 1-844-347-7805, Monday through Friday from 7:00 a.m. to 7:00 p.m. First Medical will send you the Compliance Program free of charge within five (5) business days of the receipt of your request.