Fraud, Waste and Abuse
Compliance Policies and Processes | Reporting Procedures | Laws & Regulations | Training | News | Program Integrity Links
Compliance Policies and Processes
Reporting Procedures
- Institutionalized or Incarcerated Referral Form
- Potential Fraud, Waste and Abuse Referral Form
- Provider Self-Audit and Referral Form
- Ethics Hotline (888) 293-3027
- VBH-PA Compliance Department Contact Information
Laws and Regulations
- Balanced Budget Act
- Deficit Reduction Act
- Federal False Claims Act (2008 correction)
- Federal False Claims Act (original)
- US Title 18 - Crimes and Criminal Procedure
- 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)
Training
- Program Integrity Presentation PowerPoint (January 2011)
- Program Integrity Tips
- OIG — A Roadmap to Avoid Fraud and Abuse
- 2011 Provider Compliance Training Make-Up
News
- Miami Doctor Sentenced to 235 Months in Prison for Medicare Fraud Scheme (6/27/11)
- Feds Make Medicare Fraud Arrest in Tampa (2/17/11)
- OIG's Most Wanted HealthCare Fugitives (2/04/11)
- Behavioral counseling company owner sentenced to prison for fraud scheme (1/11/11)
- Mother and daughter charged with fraud, theft and endangering a family member in Montgomery County neglect case (12/2/10)
- Pennsylvania foot doctor arrested in $155,000 Medicaid fraud (1/4/10)
Program Integrity Links
- Audits – Medicaid RAC
- HHS Fraud, Waste, and Abuse Report – December 2011
- Pennsylvania Department of Public Welfare Fraud and Abuse Page
- 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
