Providers who participate in the Maryland Public Behavioral Health System (PBHS) are subject to announced and unannounced audits by Carelon Behavioral Health. Providers are selected for an audit based on random selection, unusual service patterns, billing outliers, high utilization, need to evaluate overall service delivery, practice patterns that may constitute fraud, waste, or abuse, and at the recommendation of and approval by BHA and/or Medicaid. Carelon Behavioral Health uses audit tools approved by Medicaid and the Behavioral Health Administration (BHA).
To learn more about compliance and provider audits, review the PBHS Provider Manual (Chapter 12).
Audit Trainings