Report Fraud

Fraud, waste and abuse

Health care fraud, waste and abuse hurts everyone including members, providers, taxpayers and CareSource. As a result, CareSource has a comprehensive fraud, waste and abuse program in our Special Investigations Department. Help us by reporting questionable situations.

Examples of member fraud, waste and/or abuse include:

  • Sharing ID cards with others
  • Selling prescription drugs or other prescribed equipment to others to make money
  • Changing prescription forms to get more than the amount of medication prescribed by their physician

Use your ID card only for your needed medical services; do not sell your prescribed drugs or equipment, and; do not alter your prescriptions as this is considered fraud. If you know of any member fraud, waste and/or abuse report it using the contact information below.

Providers also can perform fraud, waste and abuse. Some examples include:

  • Billing for services not provided
  • Prescribing drugs or services that are not medically necessary
  • Scheduling more frequent return visits than are needed
  • Balance billing members for services

If you know of or become aware of provider fraud, waste and abuse, please let us know by using the contact information below.

You can report fraud, waste and abuse to CareSource by:

  • Calling 1-800-390-7102 (TTY for the hearing impaired: 1-800-649-3777 or 711) and selecting the appropriate menu option for fraud
  • Sending an e-mail to fraud@caresource.com
  • Faxing: 1-800-418-0248
  • Writing a letter to:

    CareSource
    Attn: Special Investigations Unit
    P.O. Box 1940
    Dayton, OH 45401-1940
    Or you may choose to use the Fraud, Waste and Abuse Reporting Form

You may also report fraud directly to the Michigan Department of Community Health (MDCH) by:

  • Calling 1-866-428-0005
  • Writing:

    Medicaid Integrity Program Section
    Capitol Commons Center Building
    400 South Pine Street, 6th Floor
    Lansing, MI 48909

When you report fraud, waste, or abuse, please give as many details as you can, including names and phone numbers. You may remain anonymous, but if you do we will not be able to call you back for more information. Your report will be kept confidential to the extent permitted by law.

 

Explanation of Benefit Statement for Medicaid Members

To assist CareSource in identifying potentially fraudulent or abusive medical billing or medical identity theft, CareSource will send Explanation of Benefit Statements to randomly selected member households on a quarterly basis.    This statement is not a bill.  These statements explain medical services that were billed to CareSource and how these benefits were paid.   These statements tell:

  • The member who received the medical service(s).
  • The name of the provider who billed the medical service(s)
  • The date the medical service(s) was received.
  • A description of the medical service(s).
  • The amount paid for the medical service(s).

Please let us know if you did not receive these services for you or your family or that someone may be using your CareSource ID card by contacting our Special Investigations Unit below.

You can report suspected fraud to us by:

  • Calling 1-800-390-7102 (TTY:  1-800-649-3777 or 711) and choosing the menu option for reporting fraud
  • Sending an e-mail to fraud@caresource.com
  • Visiting our website at www.caresource.com  and use the Fraud, Waste and Abuse  Reporting Form
  • Writing us at:

    CareSource
    Attn:  Special Investigations Unit
    P. O. Box 1940
    Dayton, OH 45401-1940

Thank you for helping CareSource in keeping fraud out of healthcare.