Program Integrity: Potential Fraud, Waste or Abuse Referral

Submitted by jduran2 on

The DMH/DD/SUS Program Integrity (PI) Team investigates fraud, waste and abuse as well as complaints and concerns regarding publicly funded and supported services. You are encouraged to to make a report and may choose to remain anonymous. All complaints and referrals are kept confidential and are protected from disclosure. The DMH/DD/SUS will not reveal your identity to any person, except as required by law.

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The DMH/DD/SAS Program Integrity (PI) Team investigates fraud, waste and abuse as well as complaints and concerns regarding publicly funded and supported services. You are encouraged to to make a report and may choose to remain anonymous. All complaints and referrals are kept confidential and are protected from disclosure. The DMH/DD/SAS will not reveal your identity to any person, except as required by law.

Examples of Fraud

  • Billing services not provided
  • Falsifying credentialing application
  • Falsifying client records
  • Kickbacks – the receipt of anything of value for the referral of consumers.

Examples of Waste

  • Providing services not medically necessary.
  • Failure to adhere to the requirements of the service definition.

Examples of Abuse

  • Using treatments that are not evidence-based
  • Using a higher cost treatment when a lower cost treatment could be equally effective
     

If there are questions and concerns or if you need assistance with this referral, please contact the DMH/DD/SAS Program Integrity (PI) Team at DMHmonitoring@dhhs.nc.gov.

Referrals can be submitted the following ways:

  1. Electronically, by selecting the "Click to submit a referral electronically" button located below.
  2. Mailing a completed referral form to:           
    Division of MH/DD/SAS
    ATTN:  Program Integrity
    3001 Service Center
    Raleigh, NC 27699-3001