Program Integrity Department
Compliance Policies and Processes
- Fraud, Waste and Abuse Policy
- Audit Process
- Audit Appeals Process
- Minimum Provider Documentation Standards for Payment
- Program Integrity Audit Findings List
Compliance Plan Requirements
- Program Integrity Tips
- Контрольный список программы соответствия поставщикам
- Обзор системы внутреннего контроля
- DHS BH-MCO Regional Training
- Physician Roadmap: Avoiding Medicare and Medicaid Fraud and Abuse
Reporting Procedures
- Institutionalized or Incarcerated Referral Form
- Potential Fraud, Waste and Abuse Referral Form
- Provider Self-Audit and Referral Form
- Call 1-888-293-3027 and speak with a representative
- Online: https://beaconsafetosay.ethix360.com/
- Via mail:
- InTouch Attn: Beacon Health Options 3100 West Lake Street Suite 325 Minneapolis, MN 55416
Name | Phone | |
Bradley Eckels, MA, LPC Manager of Program Integrity | 724-744-6520 | Bradley.Eckels@beaconhealthoptions.com |
Sandra Leisifer Program Integrity Auditor | 724-744-6527 | Sandra.Leisifer@beaconhealthoptions.com |
Christina Smouse, B.S. Program Integrity Auditor | 724-744-6584 | Christina.Smouse@beaconhealthoptions.com |
Mailing Address: Beacon Health Options, P.O. Box 1840, Cranberry Township, PA 16066-1840 Confidential Fax: 1-888-752-8010 |
Laws and Regulations
- Balanced Budget Act
- Закон о сокращении дефицита
- Federal False Claims Act (2008 correction)
- Federal False Claims Act (original)
- Federal Regulation 42 Title VI (included Medicaid Managed Care ?438)
- Fraud Enforcement and Recovery Act
- Patient Protection and Affordable Care Act
- Health Information Portability and Accountability Act (HIPAA)
- Health Information Technology for Economic and Clinical Health Act (HITECH)
- Pennsylvania Code – Fraud and Abuse Sanctions (1101.77)
- Pennsylvania Code – Provider (1101.75) and Recipient (1101.92) Prohibited Acts
- Pennsylvania Code – Medicaid Provisions (Medical Assistance Provisions)
Тренинги
- 2020 Trainings
- 2019 Trainings
- 2018 Trainings
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2017 Trainings
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2016 Trainings
-
2015 Trainings
- 2015 BHRS Summit – Compliance Topics for BHRS
- Clinician/Staffing Requirements Training – 2015 Updates
- Compliance Considerations: School Based Services
- Methadone Compliance Training Part I – Psychotherapy Requirements
- Methadone Compliance Training Part II – Documentation Requirements
- Family Based Mental Health Services Training 05/15/2015 – Clinical Practice Standards
- Family Based Mental Health Services Training 05/15/2015 – Search for Compliance
- Documentations Requirements – Part 1: Consent and Treatment Plans
- Documentations Requirements – Part 2: Progress Notes and Encounter Forms
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2014 Trainings
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2013 Trainings
- 2013 Compliance Webinar Series: The Search for Compliance (May 2013)
- Part I – Provider Responsibilities
- Part II – Outpatient Psychiatric Services
- Part III – Recipient Verification Requirements
- Part IV – Provider Self-Audits
- Part V – Compliance Topics for Certified Peer Support
- Part VI – Compliance Audits & Record Requests
- Part VII – Compliance Topics for BHRS
- Part VIII – Compliance Topics to Staffing Requirements
- Part IX – Compliance Topics for RTF
- Part X – Compliance Audits
- 2013 Compliance Webinar Series: The Search for Compliance (May 2013)
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Archived Trainings
- 2011 Provider Compliance Training Make-Up
- DPW BH-MCO Regional Training
- Program Integrity Presentation PowerPoint (January 2011)
- Program Integrity Tips
- OIG — A Roadmap to Avoid Fraud and Abuse
Provider Fraud
- http://www.modernhealthcare.com/article/20150905/NEWS/150909922
- http://www.cchrint.org/2015/06/29/psychiatrists-over-represented-in-commission-of-fraud/
- http://www.bizjournals.com/philadelphia/blog/health-care/2015/07/martinez-chlebowski-allentown-fraud-mental-health.html
- http://www.smartbrief.com/s/2016/01/nc-woman-receives-over-2-years-role-medicaid-fraud-ring
Member Fraud
integrityProgram Integrity Links
- Audits – Medicaid RAC
- HHS Fraud, Waste, and Abuse Report – December 2011
- Department of Health and Human Services (DHS)
- Code of Federal Regulation (TITLE 42-Public Health, Chapter IV-CMS, DHHS, SUBCHAPTER C-Medical Assistance Programs, Part 455- Program Integrity: Medicaid)
- Office of Inspector General (OIG)
- Center for Medicare and Medicaid Services (CMS)
- National Association of Medicaid Fraud Control Units (NAMFCU)
- Pennsylvania Attorney General
- Pennsylvania Bureau of Program Integrity