Report Fraud, Waste and Abuse
CareSource has a comprehensive fraud and abuse program designed to handle cases of fraudulent and abusive activity by CareSource providers, members and employees. You can help by reporting suspected fraud to us.
Some examples of provider activity that is monitored for fraud and abuse are:
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Providing unnecessary services to members.
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Prescribing unnecessary drugs.
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Failing to provide Medicaid managed care patients services that are comparable to those provided to patients with commercial or fee-for-service Medicaid coverage.
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Billing members.
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Inflating a bill for services.
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Billing more than once for the same service.
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Intentionally using improper codes on claims to receive a higher rate of reimbursement.
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Billing for services not rendered.
CareSource monitors member activity for fraud and abuse as well. Some examples are:
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Inappropriately using services such as selling prescribed narcotics or durable medical equipment.
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Sharing a CareSource member ID card with someone who is not a CareSource member.
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Submitting fraudulent Babies First coupons.
CareSource also wants to know about fraudulent employee activity. Some examples are:
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Receiving gifts or kickbacks from CareSource vendors for goods or services purchased by CareSource.
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Inappropriately marketing our company to potential CareSource members.
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Behaving in an unethical or dishonest manner while performing company business.
You can report fraud, waste and abuse to CareSource by:
CareSource
Attention: Special Investigations Unit
P.O. Box 1940
Dayton, OH 45401-1940
Please give a detailed description of the activity, including the:
- Provider/member/employee name
- Provider/member number
- Date of activity
- All other pertinent information
Or fill out the Fraud, Waste and Abuse reporting form. Your report may be anonymous; however, if you do not leave your name, we will not be able to call you back for more information. Your message will be kept confidential to the extent allowed by law.
Under the Deficit Reduction Act of 2005, CareSource is required to provide information about the federal False Claims Act, state False Claims Acts, and other state laws regarding Medicaid fraud. Find out more about the False Claims Act.
Thank you for your assistance in keeping fraud out of health care.