Spokane County Regional Behavioral Health Organization (SCRBHO) Fraud & Abuse Suspected Violation Report

2. TO REPORT A SUSPECTED VIOLATION:

   Report suspected violations to the CSHCD/SCRBHO Compliance Officer at (509) 477-4510, or any member of the Compliance Committee, or the CSHCD/SCRBHO Department Director at (509) 477-7561 or designees OR call the OIG’s National Fraud Hotline 1-800-447-8477; Washington State Auditor’s Hotline 1-866-902-3900 OR submit a written or electronic report to the CSHCD/SCRBHO Compliance Officer via the SCRBHO Compliance/Fraud & Abuse Report form below:

   Report suspected violations to the CSHCD/SCRBHO Compliance Officer at (509) 477-4510, or any member of the Compliance Committee, or the CSHCD/SCRBHO Department Director at (509) 477-7561 or designees OR call the OIG’s National Fraud Hotline 1-800-447-8477; Washington State Auditor’s Hotline 1-866-902-3900 OR submit a written or electronic report to the CSHCD/SCRBHO Compliance Officer via the SCRBHO Compliance/Fraud & Abuse Report form below:

4. The SCRBHO Compliance/Fraud & Abuse Report form can be printed here:

   The SCRBHO Compliance/Fraud & Abuse Report form can be printed here:

6. Report Form

   SCRBHO Compliance/Fraud & Abuse Report Form

   Please mail form to: Kathleen Torella, Compliance Officer Spokane County CSHCD 312 W. 8th Avenue Spokane, WA 99204

8. Confidentiality:

   Individuals may report suspected violations anonymously. The SCRBHO shall treat reports of suspected violations or misconduct as confidential to the greatest extent possible. The SCRBHO shall take reasonable steps to maintain confidentiality of the identity of any person providing information to the SCRBHO. However, the SCRBHO cannot guarantee complete confidentiality of the identity of persons who make reports, due to the SCRBHO’s obligations to investigate, take appropriate action to correct violations or misconduct, and its obligations to report certain issues to state and/or federal authorities. Additionally, the SCRBHO cannot make promises regarding a person’s liability or steps the SCRBHO may take in response to the report. By law, your employer may not retaliate against you for making good faith reports of potential violations.

   Individuals may report suspected violations anonymously. The SCRBHO shall treat reports of suspected violations or misconduct as confidential to the greatest extent possible. The SCRBHO shall take reasonable steps to maintain confidentiality of the identity of any person providing information to the SCRBHO. However, the SCRBHO cannot guarantee complete confidentiality of the identity of persons who make reports, due to the SCRBHO’s obligations to investigate, take appropriate action to correct violations or misconduct, and its obligations to report certain issues to state and/or federal authorities. Additionally, the SCRBHO cannot make promises regarding a person’s liability or steps the SCRBHO may take in response to the report. By law, your employer may not retaliate against you for making good faith reports of potential violations.

10. SCRBHO Compliance/Fraud & Abuse Report Form

    Please complete the following fields to report a suspected or known SCRBHO Compliance/Fraud & Abuse violation:

    Please complete the following fields to report a suspected or known SCRBHO Compliance/Fraud & Abuse violation:

12. Description of suspected violation*

14. Name of individual and/or group suspected of committing the violation*

16. Date(s) the suspected violation occurred or is occurring*

17. Date(s) the suspected behavior or violation was discovered*

19. Reason for believing a violation has occurred.*

21. Description regarding how the suspected violation was discovered*

23. Any other information that may be helpful to the investigation or understanding of the situation*

25. Providing your name and contact information is not required to submit a report. If you would like to do so, please complete the following fields:

27. First Name

28. Last Name

30. Phone Number

31. Email Address

Leave This Blank:


33. 1. Receive an email copy of this form.
34. Email address

    This field is not part of the form submission.

35. Submit Submit and Print

* indicates a required field