Fraud, Waste, and Abuse Information

It is the policy of Community Care to support the Corporate Fraud, Waste, and Abuse (FWA) Program.  The program, established in 2000, promotes the highest level of ethical and lawful conduct throughout the organization.  On an ongoing basis, the program is evaluated in order to ensure that all state and federal regulations and appropriate county requirements related to FWA are being followed and contractual obligations are being met. Below you will find educational information for Providers related to Fraud, Waste, and Abuse.

Policies & Procedures
Fraud, Waste, and Abuse (Compliance) Auditing	66KB	9 pages	PDF
Fraud and Abuse Policy and Procedure	40 KB	4 pages	PDF
False Claims Act	50KB	6 pages	PDF
Provider Fraud, Waste, and Abuse Audit Appeal	23KB	2 pages	PDF
Chart Audit Exceptions and Corrective Actions	74 KB	4 pages	PDF

Trainings

OMHSAS BPI MCO FWA Presentation (PDF)

BHRS Provider Training

Outpatient Mental Health Clinic Training

Outpatient Mental Health Practitioner Training

Peer Support Provider Training

Psychiatric Rehabilitation Provider Training

STAP Provider Training

Fraud and Abuse Hotline

Community Care has established a hotline for reporting suspected fraud and abuse committed by any entity providing or receiving Medical Assistance Services. Callers may leave a voicemail message including their name and telephone number where they can be reached along with details surrounding the case. Reports can also be made anonymously to the hotline. Individuals may also email their fraud and abuse concerns to CCBH_Fraud_Abuse@upmc.edu

Fraud and Abuse Hotline:

1-866-445-5190