Fraud, Waste and Abuse Policies and Processes | Reporting Procedures | Training | Additional Resource Links
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Fraud, Waste and Abuse Policies and Processes
reporting
Reporting Procedures
- Potential Fraud, Waste and Abuse Referral Form
- Provider Self-Audit and Referral Form
- Providers: Call 1-877-615-8503 and speak with a representative
- Members: Visit http://pa.carelon.com/members/
- Online: https://www.fighthealthcarefraud.com/
- Select Carelon under the drop-down for “Who is the insurance company?”
- Email: BHSIU@carelon.com
Carelon SIU Department Contact Information
Mailing Address: Carelon SIU, 5800 Northhampton Blvd., Norfolk, VA. 23502 Email: BHSIU@carelon.com |
training
Trainings
Mandatory Annual Training
Archived Trainings
- 2021 Trainings
- 2020 Trainings
- 2019 Trainings
- 2018 Trainings
- 2017 Trainings
- 2015 Trainings
- 2015 BHRS Summit – Compliance Topics for BHRS
- Clinician/Staffing Requirements Training – 2015 Updates
- Compliance Considerations: School Based Services
- Methadone Compliance Training Part I – Psychotherapy Requirements
- Methadone Compliance Training Part II – Documentation Requirements
- Documentations Requirements – Part 1: Consent and Treatment Plans
- Documentations Requirements – Part 2: Progress Notes and Encounter Forms
- 2014 Trainings
- 2014 Annual Fraud and Abuse Training for All Providers
- BHRS Summit Fraud and Abuse Training
- RTF Summit Fraud and Abuse Training
- Outpatient Psychiatric Services
- 2013 Trainings
- 2013 Compliance Webinar Series: The Search for Compliance (May 2013)
- Part I – Provider Responsibilities
- Part II – Outpatient Psychiatric Services
- Part III – Recipient Verification Requirements
- Part IV – Provider Self-Audits
- Part V – Compliance Topics for Certified Peer Support
- Part VI – Compliance Audits & Record Requests
- Part VII – Compliance Topics for BHRS
- Part VIII – Compliance Topics to Staffing Requirements
- Part IX – Compliance Topics for RTF
- Part X – Compliance Audits
- 2011 Provider Compliance Training Make-Up
additional
Additional Resource Links
- Department of Health and Human Services (DHS)
- Code of Federal Regulation (TITLE 42-Public Health, Chapter IV-CMS, DHHS, SUBCHAPTER C-Medical Assistance Programs, Part 455- Program Integrity: Medicaid)
- Office of Inspector General (OIG)
- Center for Medicare and Medicaid Services (CMS)
- National Association of Medicaid Fraud Control Units (NAMFCU)
- Pennsylvania Attorney General
- Pennsylvania Bureau of Program Integrity
- Pennsylvania Code – Fraud and Abuse Sanctions (1101.77)
- Pennsylvania Code – Provider (1101.75) and Recipient (1101.92) Prohibited Acts
- Pennsylvania Code – Medicaid Provisions (Medical Assistance Provisions)