Quality and Compliance Oversight
Guardian Health Services (GHS) operates an internal Quality Assurance (QA) Program and Compliance Program. The Quality Assurance program is designed to objectively and systematically monitor and evaluate the extent to which the programs offered by GHS to contracted entities and their respective patients, family members, and providers satisfy contractually based commitments, and the established mission and program specific goals of GHS. Operation of the QA Program is guided by an internal Quality Assurance and Medical Standards Committee. The committee is composed of licensed and active physician providers who are members of the Guardian Health Services Clinically Integrated Network (CIN), ancillary service providers, and is chaired by THE Guardian Health Services Chief Quality Officer.
The GHS Compliance Program is designed to promote adherence to appropriate standards of business conduct throughout all aspects of the GHS operations and ensure compliance with applicable federal, state, and local statutory and regulatory obligations by GHS as well as the contracted entities (i.e., Privacy Act of 1974, HIPAA, Health Information Technology for Economic and Clinical Health [HITECH] Act). The Program operates from policies and procedures that ensure compliance to regulations that govern sharing of personal health information (PHI) and vigilant surveillance of fraud, waste, and abuse, including 1) initial and annual mandatory fraud, waste, and abuse training for GHS staff and business associates, 2) monitoring contracted entities for potential fraud, waste, and abuse, and 3) reporting fraud, waste, and abuse to appropriate agencies and organizations.