Blue Ridge Health expects its patients, staff, Board of Directors, vendors/contractors, and any other individual affiliated with Blue Ridge Health to report concerns, suspected violations and/or irregularities of the BRH Compliance Plan, Code of Conduct, laws, rules or regulations, including any identified issues or questions associated with our policies or procedures with respect to any Federal health care program (e.g. Medicaid, Medicare). It is the policy of Blue Ridge Health to provide a procedure through which our patients, staff, or other any other individual affiliated with Blue Ridge Health may confidentially report their questions or concerns without fear of retribution or retaliation. If a patient, staff member, vendor/contractor, or any other individual affiliated with Blue Ridge Health desires to remain completely anonymous, the individual may submit his/her report through the Blue Ridge Health Corporate Compliance Hotline (828) 233-2238 or by emailing your compliance concern to compliance@brchs.com. No adverse action or retribution of any kind will be taken by Blue Ridge Health against any patient, employee, vendor/contractor, or any other individual because he or she reports in good faith any concerns or suspected violations.

BRH COMPLIANCE, HIPAA PRIVACY, HIPAA SECURITY OFFICERS

Blue Ridge Health has appointed a senior administrative staff to serve as the organization’s Compliance Officer, HIPAA Privacy Officer, and HIPAA Security Officer. If any person has a concern about patient care and/or safety as it relates to HIPAA, we encourage telephone follow-up with our organization’s Compliance Officer at 828.233.2238, or by emailing compliance@brchs.com.

JOINT COMMISSION

Blue Ridge Health is accredited by the Joint Commission for Ambulatory Health Care and is recognized as a Primary Medical Care Home. If you have contacted BRH to discuss your issue, but feel that your concern was not resolved through the BRH complaint and/or grievance process, you, or a representative of your choice may contact the Office of Quality Monitoring of the Joint Commission by either calling 1.800.994.6610, or sending an e-mail to complaint@jointcommission.org or visiting www.jointcommission.org for more information.

Medicaid reports of Fraud, Waste or Abuse

You are encouraged to report matters involving Medicaid fraud and abuse. You may remain anonymous; however, sometimes to conduct an effective investigation, staff may need to contact you. Your name will not be shared with anyone investigated. In rare cases involving legal proceedings, your name may need to be revealed.

Medicaid fraud and abuse is when a person knowingly cheats or is dishonest, resulting in a benefit such as payment or coverage.

Examples of Medicaid fraud and abuse:

• An individual does not report all income when applying for Medicaid
• An individual does not report other insurance when applying for Medicaid
• A non-recipient uses a recipient's card with or without the recipient's knowledge
• A provider’s credentials are not accurate
• A provider bills for services that were not rendered
• A provider performs and bills for services not medically necessary

Reporting OptionS:

DHHS Customer Service Center
Phone: 800-662-7030 (English or Spanish)
Online Confidential Complaint Form

Medicaid Fraud, Waste and Program Abuse Tip-Line
Phone: 877-DMA-TIP1 (877-362-8471)

State Auditor Waste Line
Phone: 800-730-TIPS