Fraud, Waste, and Abuse

Fraud, Waste, and Abuse

CareSource has a program designed to handle cases of managed care fraud.  Fraud can be committed by providers or members.  Examples of provider fraud include doctors or other health care providers who:

·        Prescribe drugs, equipment or services that you feel are unnecessary

·        Schedule more frequent return visits than you feel are necessary

·        Bill for services not provided to you

The following examples are considered member fraud.  CareSource monitors these member activities:

·        Members who share their CareSource ID card with another person

·        Members who sell prescribed drugs or other medical equipment paid for by CareSource to others

IF YOU SUSPECT FRAUD

If you think a doctor or a CareSource member is committing fraud, you can:

·        Call us at 1-800-993-0780 (TTY: 1-800-750-0750) and select the menu option for reporting fraud, or

·        Send an e-mail to fraud@caresource-ohio.com.

Please leave a detailed message. Include names and phone numbers of those involved, if you have them. You do not have to leave your name. However, if you don’t, we will not be able to call you back for more information. Your message will be kept confidential whenever possible.