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Medicare Patients with Diabetes – Beware of this Scam

Although the precise method may vary, the scheme generally involves someone pretending to be from the Government, a diabetes association or even Medicare, calling you to offer "free" diabetic supplies such as glucose meters, diabetic test strips or lancets. The caller may also offer other supplies such as heating pads, lift seats, foot orthotics or joint braces in exchange for your Medicare or financial information, or ask you to confirm this type of personal information. Additionally, you may receive items in the mail that you did not order.

Suspect a scam? Report fraud here.

This information appears in an article written by Roberta Baskin and published on the website of the Office of the Inspector General, U.S. Department of Health and Human Services.

Fraud, waste and abuse

CareSource has a comprehensive fraud, waste and abuse program in our Special Investigations Department designed to handle cases of managed care fraud. Help us by reporting questionable situations.

Fraud can be committed by members, providers or pharmacies. 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
  • Members who misrepresent personal information, such as identity, eligibility, or a medical condition in order to receive benefits
  • Members who do not disclose other medical/prescription coverage
  • Members who seek out multiple physician/pharmacies to receive prescriptions for controlled substances or other types of medications
  • Changing prescription forms to get more than the amount of medication prescribed by your doctor

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

  • Prescribe drugs, equipment or services that are not medically necessary
  • Schedule more frequent office visits than are needed
  • Bill for tests and services not provided
  • Bill members for covered services
  • Bill more than once for the same service
  • Unbundle services to obtain higher reimbursement

Examples of Pharmacy fraud, waste and/or abuse include:

  • Prescription drugs that were not dispensed as written
  • Submitting claims for a more expensive brand name drug when a less expensive generic prescription drug is dispensed
  • Dispensing less than the prescribed quantity and then not informing or arranging for the additional portion of the prescription to be received by the member

If you suspect fraud, waste or abuse

If you think a doctor, pharmacy or a CareSource member is committing fraud, you should report it to us by:


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

You do not have to use 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 suspected fraud, waste and/or abuse, please give us detailed information that includes a clear description of what you believe has happened and 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, so leave as many details as possible. Your report will be kept confidential to the extent permitted by laws.

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




 Updated October 1, 2013

H6178_OHMSNP773
CMS Approved 11/12/13