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Member Services Phone Number 888.301.1228

Compliance

Gold Coast Health Plan has various methods in place in which Providers, Members, vendors and employees can report suspected fraud, waste or abuse. Reports can be made anonymously.

  • Toll-free hotline available 24/7: 866.672.2615
  • Via internet: gchp.alertline.com
  • Written report: Attention: Compliance Officer–Fraud Investigation
    711 East Daily Drive, Suite 106
    Camarillo, CA 93010-6082

Please provide as much information as possible such as:

  • 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.
  • Description and details of the suspected fraud, waste or abuse: who, what, where, when, and date and time of incident or incident(s).
  • Documentation (any) that is related to the report.
  • Person filing the report: name and telephone number if you do not wish to remain anonymous.

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 healthcare. 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))

Attention Providers: You are required to report incidents of fraud to Gold Coast Health Plan 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
Governor Brown approved SB 272 in October 2015, adding section 6270.5 to the California Public Records Act (the “Act,” Government Code Sections 6250-6276.48). 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. Stated plainly, SB 272 requires local agencies to create a catalog of multi-departmental systems or systems containing information about the public that store original records and post the catalog on their agency website.

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, however, the Act's other provisions pertaining to disclosure of such records still apply.

Approved on October 11, 2015, SB272 adds a section to the California Public Records Act requiring local agencies to create a catalog of Enterprise Systems by July 1, 2016 with annual updates. Click here to download.

Click here to download to the full text of SB 272

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