Report Fraud

Fraud, waste and abuse

CareSource has a comprehensive fraud, waste and abuse program in our Special Investigations Department designed to handle 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 physician

Examples of provider fraud, waste and/or abuse include doctors or other health care providers who:

  • Prescribe drugs, equipment or services that you feel are not medically necessary
  • Schedule more frequent return visits than you feel are necessary
  • Bill for tests and services not provided to you
  • Unbundle medical services to obtain a higher reimbursement

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:

  • Calling 1-800-993-0780 (TTY: 1-800-750-0750 or 711) and selecting the menu option for reporting fraud; or
  • Writing us a letter or complete 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 ways 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:

Fraud Email: fraud@caresource.com

Fraud Fax: 1-800-418-0248

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

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