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Cumplimiento e informes

Reporting

Cómo hacer un informe

Para realizar un informe de forma anónima y electrónica, visite: www.gobhi.ethicspoint.com

Para hacer un reporte de forma anónima por teléfono llame al 1-844-773-7237

Report Types

Fraud

When someone lies or cheats on purpose to get money or benefits they are not allowed to have.

 

Examples:

  • A clinic bills insurance for a visit that never happened.

  • Someone uses another person’s insurance card to get care.

  • A provider changes paperwork to make it look like a more expensive service was done.

Waste

When money is used carelessly or unnecessarily, even if no one meant to do anything wrong.

 

Examples:

  • Ordering medical tests that are not needed.

  • Throwing away unused medical supplies that could still be used.

  • Scheduling extra appointments that don’t help the patient.

Abuse

When someone uses the rules the wrong way to get more money or benefits than they should, even if they didn’t plan to cheat.

 

Examples:

  • Billing for a longer appointment than actually happened.

  • Charging for services that were not really needed.

  • Using the wrong billing code to get paid more money.

​Privacy or Security (HIPAA & 42 CFR Part 2)

A privacy or security incident happens when someone sees, shares, loses, or hacks private health information when they should not.

 

Examples: 

  • Treatment records were lost or hacked.

  • A provider discusses the care you've received with people who are not approved to have the information.

  • A provider is denying you a copy of your treatment records.

  • Your substance use disorder treatment was shared with your employer.

Ethics

When someone does not act in a fair, honest, or respectful way, even if no law or rule was broken.

​

Examples

  • A gift was given to someone in order for beneficial treatment.

  • Inappropriate boundaries or relationships between providers and clients.

  • Violating any member's rights to care.

Records Requests

GOBHI Behavioral Health Program Records

To request records related to services provided directly by GOBHI please download and submit the GOBHI Records Request Form online. You must submit proof of identity or right to records. GOBHI will review your request, follow up for additional information, and provide records or a response within 30 days. For additional questions please contact HIPAA@GOBHI.ORG.

EOCCO Records

For EOCCO member records please contact EOCCO Customer Service: 888-788-9821 (TTY: 711) — available Monday–Friday, 7:30 a.m.–5:30 p.m. Pacific Time. Or via email EOCCOmedical@eocco.com. 

Provider Records

To request records from an EOCCO Behavioral Health Care Provider such as a Community Mental Health Program or other contracted behavioral health care providers please reach out directly to those providers and ask for records request procedures.

Grievances

How to Submit a Grievance: 

GOBHI Behavioral Health Program Grievance

Per the GOBHI Behavioral Health Program Grievance Policy, participants or representatives can report a grievance either verbally or in writing. To provide a grievance in writing please download and complete the GOBHI Behavioral Health Program Grievance Form. Submit the completed grievance to compliance@gobhi.org.

EOCCO Grievance

Please contact EOCC Customer Service (to file a grievance over the phone): 888-788-9821 (TTY/OREGON RELAY: 711). For more support please visit the EOCCO Website.

Provider Grievances

To submit a grievance directly to an EOCCO Behavioral Health Care Provider such as a Community Mental Health Program or other contracted behavioral health care providers please reach out directly to those providers and ask for records grievance procedures. 

GOBHI Compliance Program

Greater Oregon Behavioral Health Inc.(GOBHI) compliance program is meant to ensure our organization and the providers we contract with and oversee through Eastern Oregon Coordinated Care Organization (EOCCO) do the right thing and follow the rules. The compliance program is built to protect clients and patients, make sure rules and laws are followed, provide access for people to report concerns and respond to them, ensure people have access to their records and their records remain private and confidential based on HIPAA and 42 CFR Part 2 rules, and provide training so that our employees, and contracted providers understand the Seven Pillars of Compliance.

Seven Pillars of Compliance

  1. Written Rules and Policies: Clear written rules that explain:

    • What is allowed

    • What is not allowed

    • How to do things the right way

  2. Identified Compliance Officer: There is a person or team in charge of compliance. Their job is to:

    • Answer questions

    • Watch for problems

    • Help fix issues

    • They help make sure the rules are followed.

  3. Training and Education: Staff are trained regularly so they understand:

    • What the rules are

    • How to spot problems

    • How to do their jobs the right way

    • Training helps prevent mistakes.​

  4. Ways to Report Problems: People are given safe ways to report concerns, like:

    • Talking to a supervisor

    • Calling a hotline

    • Sending a report

    • No one should be punished for speaking up honestly

  5. Checking and Monitoring: The organization checks its own work to look for problems.

    • Audits

    • Reviews

    • Spot checks

  6. Fair Discipline: If someone breaks the rules:

    • The organization takes it seriously

    • Consequences are fair and consistent

    • This shows that the rules matter.

  7. Fixing Problems: When a problem is found, the organization:

    • Fixes it

    • Figures out why it happened

    • Takes steps to stop it from happening again

GOBHI Compliance Contact Information

Sam Shea 

Operations and Compliance Senior Manager 

sshea@gobhi.org

For general questions: compliance@gobhi.org

For HIPAA questions: hipaa@gobhi.org

For reporting submissions or questions: gobhi.reports@gobhi.org

Main GOBHI phone line: (541) 298-2101 

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