Fraud, Waste, and Abuse

Fraud

An intentional deception or misrepresentation that is made by an individual who knows it to be false and who receives an unauthorized benefit from the action

Waste

An overutilization of services or other practices that results in unnecessary costs

Abuse

Payment for those items or services where no legal entitlement exists and for which the healthcare provider has not knowingly or intentionally misrepresented the facts to receive payment

Reporting to the CBH Compliance Hotline

If you suspect any type of fraud, waste, or abuse by a Community Behavioral Health member or employee, or by a behavioral healthcare provider, you may call the CBH Compliance Hotline or send an email to the Compliance Department to make a confidential report.

• 1-800-229-3050
• CBH.compliancehotline@phila.gov

You may leave a message on the confidential voicemail 24 hours a day, 7 days a week. To speak directly with Compliance staff, please call during the following hours:

• Monday – Friday
  9:00 a.m. – 11:00 a.m.
  2:00 p.m. – 4:00 p.m.

If you send an email, Compliance staff will respond within 48 business hours.

• CBH Compliance Hotline Flyer
• Folleto de la línea directa de cumplimiento en español

Remember: The information you provide will remain confidential.

Other Methods of Reporting

• PA Department of Human Services Fraud and Abuse Hotline: 1-866-DHS-TIPS
• U.S. Office of Inspector General Hotline: 1-800-409-9926
• Report Electronically through the U.S. Department of Health and Human Services

Publications

• Healthcare Fraud and Program Integrity: An Overview for Providers
• A Roadmap for New Physicians: Avoiding Medicare and Medicaid Fraud and Abuse