Compliance and Reporting

Greater Oregon Behavioral Health is an organization with strong values of responsibility and integrity. Our Code of Conduct contains general guidelines for conducting business with the highest standards of ethics.

GOBHI is committed to an environment where open, honest communications are the expectation, not the exception. We want to make sure our consumers, employees, and stakeholders have the ability to anonymously report concerns related to Fraud Waste and Abuse (FWA).

Fraud Waste and Abuse

Definitions

  • Fraud: An intentional deception or misrepresentation made by a person with the knowledge that the deception could result in some unauthorized benefit to him/herself or some other person.

  • Waste: Overutilization of services, or other practices that result in unnecessary costs.  Waste is generally not caused by criminally negligent actions but rather misuse of resources.

  • Abuse: An individual’s activities that are inconsistent with sound fiscal, business, or medical practices that result in unnecessary cost, reimbursement for services that are not medically necessary or fail to meet professionally recognized standards.

Examples of Fraud, Waste and Abuse:

  • Unnecessary treatments

  • Using someone else’s insurance card

  • Altering or forging a prescription

  • Providing misleading information on or omitting information from an application for health care coverage, or intentionally giving incorrect information to receive benefits

  • Billing for services not rendered and/or goods not provided

  • Knowingly enrolling someone not eligible for coverage under their policy or coverage

  • Double billing

  • Misrepresentation of services

  • Billing separately for services that should be a single service

  • Billing for services not medically necessary

  • False coding, altering records, or claims

  • Altering medical record documentation

  • Limiting access to needed services

  • Soliciting, offering or receiving a kickback, bribe or rebate

  • Misrepresentation of medical conditions

How To Make a Report

To make a report anonymously electronically please visit: www.gobhi.ethicspoint.com

To make a report anonymously by phone call 1-844-773-7237

Confidentiality / HIPAA

Greater Oregon Behavioral Health is dedicated to meeting the standards and laws detailed in the Health Insurance Portability and Accountability Act (HIPAA). To understand your rights under HIPAA please visit the U.S Department of Health and Human Services Health Information Privacy overview at https://www.hhs.gov/hipaa/for-individuals/guidance-materials-for-consumers/index.html.

Per 45 CFR Part 160 and Subparts A and E of Part 164, all HIPAA-covered entities and business associates must comply with the Privacy Rule requirements applicable to all forms of protected health information (PHI) including oral, paper, and electronic. The Privacy Rule applies to any information that may reasonably allow someone to identify an individual (e.g. Name, Address, Birthdates and dates of service, Phone numbers, E-mail addresses, Social security numbers, Health insurance plan information and Photos).

To speak directly with the GOBHI Privacy and Security Officer

Email: hipaa@gobhi.org

Phone: 541-298-2101

To make a report anonymously electronically via NAVEX / EthicsPoint: www.gobhi.ethicspoint.com

To make a report anonymously by phone via NAVEX / EthicsPoint: 1.844.773.7237

What is NAVEX / EthicsPoint?

What is EthicsPoint? EthicsPoint is a comprehensive and confidential reporting tool created by NAVEX Global to assist management and employees work together in addressing fraud, abuse, and other misconduct in the workplace, all while cultivating a positive work environment. Why do we need a system like EthicsPoint?

  • We believe that our employees are our most important asset. By creating open channels of communication, we can promote a positive work environment and maximize productivity.

  • An effective reporting system will augment our other efforts to foster a culture of integrity and ethical decision-making.