Fraud, Waste & Abuse

What Does Fraud, Waste and Abuse Look Like?

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

Providers who:

  • Order drugs, equipment or services that are not medically necessary.
  • Don’t give medically necessary services due to lower reimbursement rates.
  • Bill for tests or care that you did not have.
  • Use wrong medical coding on purpose to get more money.
  • Plan more visits than are needed.
  • Bill for more expensive care than you received.
  • Unbundle services to get a higher repayment.

Members who:

  • Share their HAP CareSource MI Health Link member ID card with another person
  • Sell prescribed drugs or other medical equipment paid for by HAP CareSource MI Health Link to others
  • Provide inaccurate symptoms and other information to health partners to get treatment or drugs

Pharmacies that:

  • Don’t give drugs as written.
  • Send claims for a brand-name drug that costs more but give a cheaper drug that costs less.
  • Give less than the prescribed amount and not letting you know to get the rest of the drug.

Do You Suspect Fraud, Waste or Abuse?

If you think a provider or a HAP CareSource MI Health LInk member is committing fraud, waste or abuse, you can report your concerns to us by:

HAP CareSource
Attn: Program Integrity
P.O. Box 1940
Dayton, OH 45401-1940

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 by:

  • Fax: 1-800-418-0248

When you report fraud, waste or abuse, please give us as many details as you can. Please give us 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 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 HAP CareSource MI Health Link 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.
  • Beware of any offers for free services or items (food, gas, gift cards, etc.) in exchange for your HAP CareSource MI Health Link member ID number.
  • Do not sign your name to a blank form. If you have questions about what you are signing, be sure to ask your health partner.

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

Member Services: 1-833-230-2057 (TTY: 1-833-711-4711 or 711), 8 a.m. to 8 p.m., Monday through Friday.

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