Program Integrity
CBH requires its provider network to act in a legal manner consistent with all applicable governmental standards and requirements and CBH contractual obligations and policies. CBH established a Program Integrity Department to facilitate adherence to these standards and policies and to prevent, detect, and mitigate incidences of fraud, waste, and abuse within the provider network. The Program Integrity Department is also responsible for credentialing independent and group practitioners, Federally Qualified Health Centers (FQHC), and their Behavioral Health Consultants (BHC).
- CBH Program Integrity Department Audit Codes
(Under the Program Integrity tab)
Audit Tools
- PA Department of Human Services Self Audit Protocol
- CBH Provider Self-Auditing Process
- Provider Self-Auditing Form
- Provider Claims Overpayment Attestation
- Claims Overpayment Spreadsheet
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.
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
Creating an Effective Compliance Plan
For CBH Providers: learn how to create an effective compliance plan, understand the requirements, and discover why a plan is crucial in our Creating an Effective Compliance Plan presentation.
CBH Compliance Forums
For videos of the 2020-2023 Compliance Forum sessions, visit the Provider Training Opportunities page.
- 2023 Compliance Forum, November 2023
- 2022 Compliance Forum, November 2022
- 2021 Compliance Forum, November 2021
- 2020 Compliance Forum, November 2020
- 2018 Compliance Forum, November 2018
