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)

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
  • 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 Monday – Friday, 9:00 a.m. – 11:00 a.m. & 2:00 p.m. – 4:00 p.m.
• CBH.compliancehotline@phila.gov
  • If you send an email, Compliance staff will respond within 48 business hours.
• CBH Compliance Hotline Flyer (English and Spanish)

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

Program Integrity Trainings

For additional training, visit Provider Training Opportunities.

• 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.
• Compliance Best Practices in the Current Federal Landscape (May 2026 Slides)

Audit Tools

• Pennsylvania Medicaid Provider Self-Review Protocol
• Original Guidance: CBH Provider Bulletin 18-17: Self-Auditing Process for CBH Providers
• CBH Provider Notice: Self-Auditing Process for CBH Providers (July 3, 2025)
• Provider Self-Auditing Form (Updated July 2025)
• Overpayment Spreadsheet (Updated July 2025)

Publications

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

Compliance Forum Archive

Compliance Matters Newsletter

• Summer 2026 Edition