Report Fraud

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.

Some examples of Provider activity that is monitored for fraud and abuse:

• Providing unnecessary services to members
• Prescribing unnecessary drugs
• Failing to provide Medicaid managed care patients with services that are comparable to those provided to patients with commercial insurance
• Billing members for covered services
• Billing more than once for the same service
• Intentionally using improper ICD-9/ICD-10/CPT/HCPCS codes on claims to receive a higher rate of reimbursement
• Billing for services not provided
• Scheduling more frequent return visits than are needed

CareSource monitors member activity for fraud and abuse as well. Some examples are:

• Inappropriately using services such as selling prescribed narcotics, or seeking controlled substances from multiple providers or multiple pharmacies
• Sharing a CareSource member ID card
• Submitting fraudulent Babies First coupons (Medicaid Only)
• Obtaining unnecessary equipment/supplies
• Changing prescription forms to get more than the amount of medication prescribed by their physician

CareSource also wants to know about fraudulent employee activity. Some examples are:

• Receiving gifts or kickbacks from CareSource vendors for goods or services purchased by CareSource
• Inappropriately marketing our company to potential CareSource members
• Behaving in an unethical or dishonest manner while performing company business

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

• Calling: 1-800-390-7102 and follow the prompts to report fraud
• Emailing: 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

• Complete the Fraud, Waste and Abuse Reporting Form

Please give a detailed description of the activity, including the:

• Provider/member/employee name
• Provider/member number, if available
• Date of activity
• Issue of concern
• All other pertinent information

• Your report may be anonymous; however, if you do not provide your name, we will not be able to call you back for more information. Your message will be kept confidential to the extent permitted by law.

  Thank you for your assistance in keeping fraud out of health care. CareSource is required to provide you with information on the False Claims Act, please see details below.

  False Claims Act

  Visit False Claims Act for more information.

  Prohibited Affiliations / 42 C.F.R. § 438.610

  CareSource is prohibited by federal and/or state provider agreements from knowingly having relationships with persons who are debarred, suspended, or otherwise excluded from participating in federal procurement and non-procurement activities. Relationships must be terminated with any trustee, officer, employee, provider or vendor who is identified to be debarred, suspended, or otherwise excluded from participation in federal or state health care programs. If you or your office management staff are excluded, you must notify us immediately.

  Avoiding Medicare and Medicaid Fraud and Abuse from the OIG

  The Office of the Inspector General (OIG) has created free educational materials to assist in teaching physicians about the Federal Laws designed to protect Medicaid and Medicare programs and program beneficiaries from fraud, waste and abuse:

  OIG Booklet:
  A Roadmap to Avoid Medicare and Medicaid Fraud and Abuse Booklet

  OIG Power Point:
  A Roadmap for New Physicians