Compliance & Quality

The Northern Michigan Regional Entity (NMRE)’s Compliance and Quality Program operates in accordance with the guidelines established by the Office of Inspector General (OIG) Guidelines for Internal Quality Assurance Programs as distributed by the Health Care Financing Administration’s (HCFA) Medicaid Bureau in its guide to states in July of 1993; the Balanced Budget Act (BBA) of 1997, Public Law 105-33; and 42 Code of Federal Regulations (CFR) 438.358 of 2002. and the U.S. Department of Health and Human Services. This program promotes high ethical standards, professionalism, quality and accountability, which aligns with the NMRE’s mission and core values.

The purpose of the Compliance Program is for:

  1. The protection of consumer information.
  2. The prevention of fraud, waste and abuse.
  3. Enforcement of federal, state, and other regulatory agency rules and regulations, as well as NMRE’s policies and procedures.
  4. Collaboration with CMHSPs, MDHHS and other PIHPs.

The Compliance Program consist of:

  1. Written policies, procedures, and Code of Ethics for all team members.
  2. A Compliance Officer and a Compliance and Quality Committee.
  3. Effective education and training mechanisms which promotes outstanding consumer care and creates an environment where team members thrive in performing their duties with integrity.
  4. Effective lines of communication including anonymous Compliance Hotline for reporting of concerns for consumers, team members, and volunteers.
  5. Systems and controls to enforce standards through well-publicized guidelines.
  6. A mechanism to implement risk assessments, internal monitoring and auditing activities and
  7. Enforcement of prompt responses to detected offenses and developing corrective actions.

 If you have questions or concerns, contact us as follows:

Compliance email address:

Compliance Hotline: 1 866 789 5774