Government Programs Vendors compliance program

Fallon Health is a non-profit organization that holds contracts with the Centers for Medicare & Medicaid Services (CMS) and the Massachusetts Medicaid program (MassHealth). To provide administrative, health care services, and prescription drug coverage to all of our members enrolled in our various government programs, Fallon Health has contractual relationships with external entities and individuals through various types of arrangements. These government programs vendors are required to comply with the contractual requirements outlined in their agreements with Fallon Health, as well as applicable State or Federal laws and regulations.

To ensure these requirements are met, Fallon Health has developed a government programs vendors compliance program that is designed to help:

  • Reinforce Fallon Health’s commitment to government programs vendors oversight and overall compliance
  • Ensure Fallon Health’s compliance with applicable laws, rules, regulations, and contractual requirements
  • Reduce fraud, waste, and abuse (FWA)

The information included on this webpage provides contracted and potential government programs vendors with an overview of the expectations associated with being a vendor for one of Fallon Health’s government programs.