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Compassionate Care, Accessible to All, for a Healthy Community

Member Services Phone Number 888.301.1228

Compliance

Gold Coast Health Plan (GCHP) has several methods in place in which providers, members, vendors and employees can report suspected fraud, waste or abuse. Reports can be made anonymously:

  • By calling the toll-free hotline, which is available 24 hours a day, seven days a week: 866.672.2615
  • Online: gchp.alertline.com
  • In writing:
    Attention: Compliance Officer–Fraud Investigation
    711 East Daily Drive, Suite 106
    Camarillo, CA 93010-6082

What is fraud, waste and abuse?

Fraud

An intentional deception or misrepresentation made with the knowledge that the deception could result in some unauthorized benefit to himself or some other person. It includes any act that constitutes fraud under applicable federal or state law. (Title 42 CFR 455.2; Welfare and Institutions Code 14043.1(i))

Waste

Overutilization of services and/or misuse of resources not caused by a violation of law.

Abuse

Provider practices that are inconsistent with sound fiscal, business or medical practices, and result in an unnecessary cost to the Medicaid program or in reimbursement for services that are not medically necessary or that fail to meet professionally recognized standards for health care. It also includes recipient practices that result in unnecessary cost to the Medicaid program. (Title 42 CFR 455.2; Welfare and Institutions Code 14043.1(a))

When filing a report, please provide as much information as possible, such as:

  • The name of person(s), facility, vendor, etc., suspected of fraud, waste or abuse.
  • Identifying information, such as: member/provider/facility name, address or telephone number.
  • Details of the suspected fraud, waste or abuse: who, what, where, when, and date and time of incident or incident(s).
  • Any documentation that is related to the report.
  • The name and telephone number of the person filing the report (if you do not wish to remain anonymous).

Attention Providers: You are required to report incidents of fraud to GCHP within 10 days from the date you became aware of such activity.

Enterprise Systems Catalog (SB 272)


Which Enterprise Systems Are Covered by SB 272
Section 6270.5 of the California Public Records Act (Government Code Sections 6250-6276.48) requires local agencies to create a catalog of multi-departmental systems or systems containing information about the public that store original records and post it on their agency website with annual updates on July 1.

Section 6270.5 defines an enterprise system as a software application or computer system that collects, stores, exchanges, and analyzes information that the agency uses that is (1) a multi-departmental system or system that contains information collected about the public and (2) a system of record. A system of record means a system that serves as an original source of data within an agency.

Which Systems Are Excluded
Enterprise systems do not include cyber security systems, infrastructure and mechanical control systems, or information that would reveal vulnerabilities to, or otherwise increase the potential for an attack on, a public agency's IT system. Additionally, section 6270.5 does not automatically require disclosure of the specific records that the IT systems collect, store, exchange or analyze. The act's other provisions pertaining to disclosure of such records still apply.

Click here to download the Gold Coast Health Plan (GCHP) Enterprise Systems Catalog.

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