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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.

Program Integrity Manual
Fraud, Waste and Abuse Provider Manual 224 KB 28 pages PDF

Policies & Procedures
Fraud, Waste and Abuse Compliance Program 820 KB 29 pages PDF
Fraud, Waste and Abuse Compliance Auditing 267 KB 9 pages PDF
False Claims Act 523 KB 10 pages PDF
Fraud, Waste and Abuse Audit Appeal 248 KB 5 pages PDF
Fraud, Waste and Abuse Chart Documentation, Audit Exceptions and Corrective Action Plans 206 KB 8 pages PDF
Fraud, Waste and Abuse Prepayment Claims Hold Audit 431KB 8 pages PDF

Trainings
Module 1: FWA Detection, Deterrence, and Prevention: FWA 101 (PDF)
Module 1: FWA Detection, Deterrence, and Prevention: FWA 101
Module 2: FWA Detection, Deterrence, and Prevention: Community Care FWA Audit Process (PDF)
Module 2: FWA Detection, Deterrence, and Prevention: Community Care FWA Audit Process
Module 3: FWA Detection, Deterrence, and Prevention: Building Compliance (PDF)
Module 3: FWA Detection, Deterrence, and Prevention: Building Compliance
BHRS Provider Training
Outpatient Mental Health Clinic Training
Outpatient Mental Health Practitioner Training
Peer Support Provider Training
Psychiatric Rehabilitation 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