FirstCare Advantage Dual SNP (HMO SNP) Medicare Compliance Program

FirstCare Advantage Dual SNP (HMO SNP) is dedicated to maintaining excellence and integrity in all aspects of its operations and its professional and business conduct.  FirstCare Advantage Dual SNP (HMO SNP)is committed to high ethical standards and compliance with all applicable governing laws, rules, and regulations, including the prohibition of misleading sales tactics.  FirstCare Advantage Dual SNP (HMO SNP) also recognizes that the detection, investigation, and prevention of fraud, waste, and abuse are vital to maintaining an affordable health care system in this state and country.

Accordingly, FirstCare Advantage Dual SNP (HMO SNP) has developed and implemented a Compliance Program and a Fraud, Waste, and Abuse (FWA) Plan to effectively articulate and demonstrate the organization’s commitment to legal and ethical conduct and to become a function of daily operations.  Compliance efforts are designed to establish an organizational culture that promotes prevention, detection, and resolution of instances of conduct that do not conform to Federal and State law, Federal and State health care program requirements (for example,  the Medicare and Medicaid programs), and FirstCare Advantage Dual SNP (HMO SNP)policies and procedures.  These efforts also intend to improve operational quality, to ensure the provision of high quality care, and to reduce fraud, waste, and abuse.

FirstCare Advantage Dual SNP (HMO SNP)has established the following mechanisms for reporting any potential compliance violation, including concerns of suspected fraud, waste and abuse or misleading sales tactics.  Reports of potential violations made by employees, agents, contractors, providers, and enrollees are maintained in a confidential manner.  These reporting mechanisms are available 24 hours a day, 7 days a week.  Reports may also be made anonymously.

The Compliance Hotline is a confidential, toll-free resource available to employees at all levels, contractors, governing body members, and FDRs, including members and providers 24 hours a day, 7 days a week to report potential incidents of FWA or to raise compliance questions or concerns. While the Compliance Hotline is available via telephone, reporters also have the option to make a report online through Calls and reports to the Compliance Hotline may be made anonymously. These communications are never traced or recorded and anyone can make a report without fear of intimidation or retaliation

Compliance Hotline1-866-399-8161

2019 Fraud, Waste, and Abuse Hotline

You may also call Medicare directly to report your concern at 1-877-7SAFERX (1-877-772-3379), the Federal OIG Fraud Hotline at 1-800-HHS-TIPS (1-800-447-8477), or the Texas OIG Fraud Hotline at 1-800-436-6184.

For more information about reporting fraud, please click here.

For more information about how FirstCare Advantage Dual SNP (HMO SNP) maintains the privacy of your health information, please click here.

Star Ratings

FirstCare Advantage Dual SNP (HMO SNP) does not have a Star Rating for 2019, as our plan is too new to be measured. Please contact FirstCare’s Customer Experience Center at 1-866-229-4969 (TTY 1-800-562-5259) for more information.


Virtual Care Powered by MDLive

We've teamed up with MDLIVE to provide our members with access to Telehealth visits to board-certified doctors, pediatricians, licensed therapists and more- using your smartphone, tablet or desktop.  ***Available January 1, 2019***

Talk to a Nurse—Nurse24™

Need care advice? Should you see a doctor? Get the info you need today! FirstCare members can talk to a nurse 24/7 by calling 1.855.828.1013 to get answers 24 hours a day, 7 days a week! TTY users can call 7-1-1 or  1.800.955.8771. Voice communication is available at 1.800.955.8770.

Utilization Management

Ever wonder how we decide what services to authorize? Our utilization management (UM) decisions are based on medical evidence and consensus of health care professionals. For more details, click here.

How to Learn More

Schedule a sit-down:
Feel free to contact us, and a FirstCare Advantage Dual SNP (HMO SNP) representative will gladly sit down with you and compare the plans in greater detail.
Call us at:
1- 866- 229-4969
We are available;
October 1- March 31, 8 a.m. to 8 p.m. Central Time (CT) daily;
April 1- September 30, 8 a.m. to 8 p.m. Central Time (CT) Monday through Friday.
For TTY or for accommodation of persons with special needs, please call TTY 1-800-562-5259.
Or, write:
FirstCare Advantage Dual SNP (HMO SNP)
Attn:  Customer Service
1901 West Loop 289, Suite 9
Lubbock, TX 79407

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