Compliance Department

The Compliance Department is comprised of three distinct yet integrated units: the Routine Investigative and Training Unit (RITU), the Special Investigative Unit (SIU), and the Network Personnel Analysis Unit (NPAU). The RITU is charged with conducting ‘routine audits’ on all CBH providers and also for ensuring that effective training related to fraud, waste and abuse is provided to CBH, DBHIDS, and provider staff. The SIU conducts targeted audits based on tips from a number of internal and external sources and assists providers, as needed, with self-audits. The NPAU leads periodic audits of provider staff files to assure that the requirements associated with delegated credentialing are being met. NPAU staff are also responsible for maintaining the Manual for the Review of Provider Personnel Files, and for analyzing data to identify potential staffing gaps and/or training issues within the system.

Compliance News and Resources

• Compliance Matters Summer 2018
• Compliance Matters Winter 2018
• Compliance Matters Summer 2017
• Compliance Matters Spring 2017
• Compliance Matters Winter 2017
• Compliance Matter Autumn 2016
• Compliance Matters Summer 2016
• Compliance Matters Spring 2016
• Compliance Matters Winter 2016
• Compliance Matters Summer 2015 
• Compliance Matters Autumn 2015 
• Fraud Waste Abuse Hotline Posting – June 2015
• Fraud Waste Abuse Hotline Posting Spanish – June 2015
• 55 PA Code – Public Welfare
• Medical Assistance Bulletin Database

Network Personnel Analysis Unit

• Supplement to the Manual for Review of Provider Personnel Files –  6-11-2018
• Manual for Review of Provider Personnel Files v.1.1 August 2014
• NPAU Provider Personnel Roster 2018

Routine Investigations and Training Unit

• Per Diem Drug and Alcohol Treatment Documentation Requirements
• Credentialing Manual
• Audit Codes
• Treatment Planning Guide

Special Investigations Unit

• CBH Fraud, Waste, and Abuse Hotline:
  • 1-800-229-3050
  • CBH.compliancehotline@phila.gov
• DHS’ Fraud and Abuse Hotline (PA)
  • 1-866-DHS-TIPS
  • Report Electronically
• OIG’s Hotline (Federal)
  • 1-800-409-9926
  • Report Electronically
• PA Department of Human Services Self Audit Protocol
• Provider Self-Auditing Form
• Provider Claims Overpayment Attestation
• Claims Overpayment Spreadsheet

Publications

• A Roadmap for New Physicians
• Health Care Fraud and Program Integrity An Overview for Providers