Incident Report at CareSphere

At CareSphere, we prioritize the safety, health, and well-being of our clients. Recognizing and promptly addressing critical incidents, complaints, and instances of program fraud and financial abuse are fundamental aspects of our commitment to providing high-quality care and ensuring continuous program improvement. This guide outlines how clients, their representatives, or family members can report incidents effectively.

Understanding What to Report
1. Complaints: Expressions of dissatisfaction regarding any aspect of our operations, activities, or services. This includes services either received or expected but not provided.
2. Program Fraud and Financial Abuse: This involves claims for services not provided, excessive charges, or any fraudulent financial activities related to our services.
3. Critical Incidents: Any event that seriously jeopardizes the health and/or welfare of an individual, such as unexpected death, serious injuries, provider misconduct, abuse (physical, psychological, sexual, verbal), neglect, exploitation, service interruption, medication errors, or preventable incidents.

For Complaints:

• Directly to CareSphere: Initially, all complaints should be directed to CareSphere’s Administrator for immediate attention and resolution.
• External Reporting: If the issue remains unresolved or if discussing it with the agency’s Administrator is not preferred, the following external channels are available:

ODP Customer Service Line: 1-888-565-9435 or email at RA-pwcustomercare@pa.gov.
Pennsylvania Department of Human Services (DHS): Complaint Hotline at 1-800-932-0313.
Disability Rights Pennsylvania: For abuse, neglect, or rights violations at 1-800-692-7443.
Local County Intellectual Disability Program: Contact your local county program associated with ODP services.
Office of Long-Term Living (OLTL) Quality Assurance Helpline: 1-866-216-3636

For Program Fraud and Financial Abuse:
Incidents involving fraudulent claims or financial misconduct related to our services should be reported directly to CareSphere’s Administrator.

For Critical Incidents:

• Immediate Action: In situations posing immediate risk, contact “9-1-1” or emergency services first.
• Report to CareSphere: Subsequently, report the incident to CareSphere’s Administrator for internal documentation and investigation.
• External Agencies: For critical incidents involving abuse, neglect, or rights violations, external agencies such as Disability Rights Pennsylvania may also be contacted for support and advocacy.

What Happens After You Report?

Investigation:
CareSphere will conduct a thorough investigation of the reported incident, led by our Supervisor or Administrator.

Review and Action:
The investigation aims for a fair, consistent, and timely review to resolve the issue satisfactorily.

Continuous Updates:
You will receive timely updates throughout the investigation and resolution process.

Documentation:
All incidents, findings, resolutions, and follow-up actions are documented confidentially.