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 are:

  • Providing unnecessary services to members
  • Prescribing unnecessary drugs
  • Failing to provide Medicaid managed care patients services that are comparable to those provided to patients with commercial or fee-for-service Medicaid coverage
  • Billing members
  • Inflating a bill for services
  • Billing more than once for the same service
  • Intentionally using improper codes on claims to receive a higher rate of reimbursement
  • Billing for services not rendered

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

  • Inappropriately using services such as selling prescribed narcotics or durable medical equipment
  • Sharing a CareSource member ID card with someone who is not a CareSource member
  • Submitting fraudulent Babies First coupons

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 the Fraud Hotline at 1-800-488-0134 and selecting the Fraud option.
  • Sending an e-mail to fraud@caresource.com
  • Sending a fax to 1-800-418-0248
  • Writing a letter to:

    CareSource
    Attn: Special Investigations Unit
    P.O. Box 1940
    Dayton, OH 45401-1940
  • Fill out the Fraud, Waste and Abuse Reporting Form. 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 allowed by law.

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

  • Provider/member/employee name
  • Provider/member number
  • Date of activity
  • All other pertinent information

When you report fraud, waste or abuse, please give us 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. 

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 click on the False Claims Act Button below for that important information.

False Claims Act

Visit False Claims Act for more information.