Fraud, Waste & Abuse

What Does Fraud, Waste and Abuse Look Like?

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

Providers who:

  • Order medications, 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 CareSource member ID card with another person
  • Sell prescribed medications or other medical equipment paid for by CareSource
  • Provide inaccurate symptoms and other information to health providers to get treatment or medications

Pharmacies that:

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

Do You Suspect Fraud, Waste or Abuse?

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

  • Calling Member Services and following the prompts for fraud. Our Fraud, Waste, and Abuse hotline is available 24 hours a day.
  • Filling out the Fraud, Waste and Abuse Reporting Form
  • Sending us a letter addressed to:

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:

When you report fraud, waste or abuse, please give us detailed information that includes:

  • A clear description of what you believe has happened.
  • The names and phone numbers of those involved if you have them.
  • As many details as possible

You can choose not to give us your name. If you choose this option, we will not be able to call you back for more information. We will only call you back if we need 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 CareSource member ID card like you would a credit card.
    • Don’t give out your member ID 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 such as food, gas or gift cards in exchange for your CareSource 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.
  • Report suspected fraud and abuse to CareSource.

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

Member Services: 1-833-230-2020 (TTY: 1-833-711-4711 or 711). We are open 8 a.m. to 8 p.m. Monday through Friday, and from October 1 through March 31 we are open the same hours, seven days a week.