Advisory Board: Contra Costa Health Plan Joint Conference Committee
Subject: Compliance Activities Report
To: Joint Conference Committee (JCC) Members
From: Sunny T. Cooper, Senior Director of Compliance and Regulatory Affairs (Interim)
Compliance Department
Date: December 19, 2025
Subject: Q4 2025 Compliance Activity Report
Purpose
This 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.
I. Executive Summary
During this reporting period, the Compliance Department continued to strengthen the organization's overall compliance posture across our Medi-Cal and Commercial lines of business while preparing for the D-SNP go live date of 01/01/2026. Our efforts focused on maintaining regulatory readiness, improving coordination between operational teams, and ensuring timely identification and remediation of compliance risks.
Regulatory monitoring remains stable. All required Medi-Cal and Medicare submissions were completed on time, and no critical findings were identified in ongoing state or federal monitoring activities. Preparations for the upcoming Department of Managed Health Care (DMHC) Financial audit are on track, with targeted workgroups addressing documentation, reporting, and operational control enhancements. The design and implementation of various compliance programs to strengthen regulatory compliance and audit readiness are also underway, prioritizing high-risk areas such as fraud prevention, privacy safeguards, and timely regulatory filings and responses.
CalAIM oversight activities ...
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