Advisory Board: CCHP Joint Conference Committee
Subject: Report from Compliance
Presenter: Sunny Cooper
Contact: Norman Hicks
Information:
Purpose
This Contra Costa Health Plan's (CCHP or "Plan" or "Division") compliance report is being submitted to provide the Joint Conference Committee (JCC) with required oversight information on the effectiveness of the Plan's Compliance Program, the status of key compliance activities, and any significant risks or issues that warrant JCC attention, in accordance with Department of Health Care Services (DHCS), Centers for Medicare and Medicaid Services (CMS) contractual obligations and Knox Keene Act of 1975 for Medi-Cal, Commercial and Medicare D-SNP managed care regulations.
Executive Summary
During this period, the Compliance Department strengthened regulatory readiness across Medi-Cal, Medicare D-SNP, and Commercial lines of business while stabilizing the D-SNP Care Plus program launched on January 1, 2026. Key highlights:
* Regulatory Monitoring: All required submissions were timely except for a few remediated delays. No critical findings were identified. A $40,000 DMHC sanction for 2018 audit deficiencies was resolved in January 2026.
* Audit Preparation: DMHC Financial Audit preparations missed initial internal deadlines due to competing priorities; revised timelines were set for February.
* Compliance Initiatives: Compliance Performance Improvement Workgroup (CPIW) projects are underway to enhance audit readiness and regulatory compliance.
* CalAIM Oversight: Enhanced Care Management (ECM) and Community Support Services (CSS) provider audits remain on schedule; corrective actions are in progress.
* Fraud, Waste & Abuse: No emerging risks; investigations and recoveries are in progress. Workforce training materials are in development.
* Privacy & Security: Low incident volume; no reportable breaches. Workforce training materials are in development.
Recommendation(s)/Next Step(s):
ACCEPT report from Compliance, RECOMMEND...
Click here for full text