Report Fraud

Fraud, waste and abuse

CareSource has a comprehensive fraud, waste and abuse program in our Special Investigations Department designed to handle cases of managed care fraud. Help us by reporting questionable situations.

Fraud can be committed by providers or members. Examples of member fraud, waste and/or abuse include:

  • 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
  • Members who use CareSource to obtain controlled substances, medical equipment, or services that they do not need
  • Changing prescription forms to get more than the amount of medication prescribed by your doctor

Examples of provider fraud include doctors or other health care providers who:

  • Prescribe drugs, equipment or services that are not medically necessary
  • Schedule more frequent office visits than are needed
  • Bill for tests and services not provided to you
  • Prescription drugs that were not dispensed as written
  • Unbundled services to obtain higher reimbursement
  • Submitting claims for a more expensive brand name drug when a less expensive generic prescription drug is dispensed

If you suspect fraud, waste or abuse

If you think a doctor or a CareSource member is committing fraud or abuse, you should report it to us by:

  • Call us at 1-877-725-4581 (TTY users call 1-800-649-3777 or 711) and selecting the menu option for reporting fraud; or
  • Writing us a letter or using or completing our Confidential Fraud, Waste and Abuse Reporting Form and sending it to:

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

You do not have to give us your name when you write or call. There are other way you may contact us that are not anonymous. If you are not concerned about giving your name, you may also use one of the following means to contact us:

When you report suspected fraud, waste or abuse, please give us detailed information that includes a clear description of what you believe has happened and the names and phone numbers of those involved, if you have them. If you choose to remain anonymous, we will not be able to call you back for more information, so please provide as many details as possible. Your report will be kept confidential to the extent permitted by laws.

 

 

 

 

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H0141_MIMSNP607
CMS Approved 12/20/2011