Report Fraud, Waste & Abuse

Leer en español

What Does Fraud, Waste and Abuse Look Like?

Health care fraud, waste and abuse can be committed by providers, members or pharmacies. Examples include the following.

Health partners who:

  • Order drugs, equipment or services that are not medically necessary
  • Schedule more visits than are medically necessary
  • Bill for tests, services or visits that you did not have
  • Bill for more expensive services than those you received
  • Continue to bill for equipment or supplies you no longer need or use

Members who:

  • Share their Humana – CareSource® ID card with another person
  • Sell prescribed drugs or other medical equipment paid for by Humana – CareSource to others
  • Provide inaccurate symptoms and other information to health partners to get treatment or drugs

Pharmacies that:

  • Do not provide drugs according to the prescription
  • Give you a generic drug and send in a claim for a more expensive brand-name drug
  • Give you less than the prescribed drug amount without telling you and without giving you the rest of the amount you should receive

Do You Suspect Fraud, Waste or Abuse?

If you think a health partner or a Humana – CareSource member is committing fraud, waste or abuse, you can report your concerns to us by:

  • Calling us at 1-855-852-7005 (TTY for the hearing impaired: 1-800-648-6056 or 711), and following the prompts for fraud. Our Fraud, Waste, and Abuse Hotline is available 24 hours a day.
  • Completing the NavigateFraud, Waste and Abuse Reporting Form and mailing it to the address below.
  • Sending us a letter addressed to:

Humana – CareSource
Attn: Special Investigations Unit
P.O. Box 1940
Dayton, OH 45401

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:

When you report fraud, waste or abuse, please give us detailed information that includes a clear description of what you believe has happened. Please also give us 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. Please leave as many details as possible. Your report will be kept confidential to the extent permitted by law.

How Can You Protect Yourself Against Fraud?

Below are a few simple tips to help protect you against health care fraud:

  • Treat your member ID card like you would a credit card. Don’t give out policy numbers to door-to-door salespeople, over the phone or on the internet. Watch out for people trying to offer you money or other free items for your personal information.
  • Read your Explanation of Benefit (EOB) statements and any papers you receive from Humana – CareSource. Are there any services, supplies or equipment listed that you did not receive? Are there any services that were billed more than once but you received only once? Did you get services on all the dates of service that are shown? If you suspect an error or fraud, report it to us using one of the methods above.

Thank you for helping Humana –CareSource keep fraud, waste and abuse out of health care.