[] COVID-19 Information and Resources: MEMBERS | PROVIDERS HOME / FRAUD, WASTE AND ABUSE Fraud, Waste and Abuse Fraud, Waste and Abuse Policies and Processes | Reporting Procedures | Laws & Regulations | Training | Additional Resource Links FRAUD, WASTE AND ABUSE POLICIES AND PROCESSES Fraud, Waste and Abuse Policy Audit Process Audit Appeals Process REPORTING PROCEDURES Potential Fraud, Waste and Abuse Referral Form Provider Self-Audit and Referral Form Provider Self-Audit Protocol Updated 06/20/2016 Attachment #1 – Beacon Claims Spreadsheet Attachment #2 – Beacon Provider Self-Audit Referral Form Attachment #3 – Beacon Provider Audit Response Attachment #4 – Beacon Provider Self-Audit Work Plan Form Call 1-888-293-3027 and speak with a representative Online: https://www.fighthealthcarefraud.com/ Select Bacon Health Options under the drop-down for “Who is the insurance company?” Email: SIU@BeaconHealthOptions.com Via mail: InTouch, Attn: Beacon Health Options, 3100 West Lake Street, Suite 325, Minneapolis, MN 55416 Beacon SIU Department Contact Information Name Email Lisa Speranzo, MBA, AHFI Program Integrity Manager, SIU Lisa.Speranzo@beaconhealthoptions.com Christina Smouse, B.S. CFE Investigator Christina.Smouse@beaconhealthoptions.com Cari Taylor, Investigator Cari.Taylor@beaconhealthoptions.com Mailing Address: Beacon Health Options, P.O. Box 1840, Cranberry Township, PA 16066-1840 Confidential Fax: 1-888-752-8010 Via Email: SIU@BeaconHealthOptions.com LAWS AND REGULATIONS Balanced Budget Act Deficit Reduction Act 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) TRAININGS 2021 Trainings 2021 Annual Fraud, Waste and Abuse Training Annual Training with Audio 2020 Trainings 2020 Annual Fraud, Waste and Abuse Training Annual Training with Audio 2019 Trainings 2019 Annual Fraud, Waste and Abuse Training Annual Training with Audio 2018 Trainings 2018 Annual Fraud, Waste and Abuse Training Annual Training with Audio Case Management Training Psychiatric Partial Hospitalization Services 2017 Trainings 2017 Annual Fraud, Waste and Abuse Training Annual Training with Audio BHRS Compliance Alternative Treatment Services Monitoring Training Training with Audio Psychiatric Rehabilitation Services: Chapter 5230 Regulation Highlights Psychiatric Rehabilitation Services Training Q&A Assessing Readiness Intensive Outpatient Services: Chapter 5200 Regulation Highlights Intensive Outpatient Services Training Q&A Peer Support Services Peer Support Services Training Q&A 2016 Trainings Annual FWA for All Providers Provider Self-Audit Protocol Self-Audit Q&A 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 2014 Trainings 2014 Annual Fraud and Abuse Training for All Providers BHRS Summit Fraud and Abuse Training RTF Summit Fraud and Abuse Training Outpatient Psychiatric Services 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 Q&A 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 Archived Trainings 2011 Provider Compliance Training Make-Up Instructions Questionnaire Page DPW BH-MCO Regional Training Program Integrity Presentation PowerPoint (January 2011) Program Integrity Tips OIG — A Roadmap to Avoid Fraud and Abuse ADDITIONAL RESOURCE 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 Nondiscrimination Notice Select Language Copyright © 2021 Beacon Health Options. 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