Fraud, Waste, Abuse & Overpayment

We have a comprehensive fraud, waste, abuse and overpayment program in our Program Integrity Department. It is designed to handle cases of managed care fraud. Let us know if you suspect any cases of fraud, waste, abuse or overpayment.

  • Fraud means the purposeful misuse of or for gain of benefits.
  • Waste means overusing benefits when they are not needed.
  • Abuse is action that causes unneeded costs to CareSource PASSE. Abuse can be caused by a provider or a member. Provider abuse could be caused by actions that do not meet good fiscal, business, or medical sense.
  • Overpayment means that CareSource PASSE may be paying for care that is not needed.

Fraud, waste, abuse and overpayment can be done by providers, pharmacies, or members. We check and act on any provider, pharmacy, or member fraud, waste, and abuse.

Please report fraud, waste, abuse and overpayment in one of these ways:

You do not have to give us your name when you write or call. If you are not concerned about giving your name, you may also send an email* or fax us. Please give us as many facts as you can. Add names and phone numbers. If we don’t get your name, we will not be able to call you back for more information. This will be kept private as allowed by law.

*If your email is not secure, people may read your email without you knowing or saying it is okay. Please do not use email to tell us anything private, like a member ID number, social security number, or health information. Instead, please use the form or phone number above. This can help protect your privacy.

Member Services: 1-833-230-2005 (TDD/TTY: 711) Monday through Friday, 8 a.m. – 5 p.m. CT