Program Integrity – Fraud, Waste, and Abuse Compliance
Community Care’s Program Integrity – Fraud, Waste, and Abuse (FWA) Compliance Program reflects the regulations, recommendations, standards, and guidance of various payer, regulatory, and law enforcement programs. Our Special Investigations Unit (SIU) uses various tools to comply with these legal and ethical responsibilities and include activities such as establishing policy & procedure, monitoring claims, conducting audits, and providing education on various program integrity topics. We hope that Community Care staff, our primary contracts, and providers across the network find the following resources helpful as we work together to detect, deter, and prevent FWA in HealthChoices behavioral health care.
FWA Provider Manual
Policies and Procedures
- Audit Appeal
- Chart Documentation, Audit Exceptions and Corrective Action Plans
- Compliance Auditing
- Compliance Program
- False Claims Act
- Prepayment Claims Hold Audit
Fraud, Waste, and Abuse Hotline
Community Care offers a telephone and email FWA hotline. Employees, providers, members administrators, vendors, and concerned others are encouraged to report suspected fraud, waste, or abuse in the HealthChoices behavioral health care (Medical Assistance) program. Telephone callers may leave a voicemail message including their name and telephone number where they can be reached along with details surrounding their concern. Reports can indicate if they wish to remain anonymous.
FWA telephone hotline: 1-866-445-5190
FWA email hotline: CommunityCareFWAHotline@ccbh.com