Fraud, Waste & Abuse
Medicaid can be misused, ending in fraud, waste or abuse. It can be done by providers, drugstores, or members. Help us by letting us know if you suspect fraud, waste, or abuse. It is handled by CareSource’s Integrity Program. Examples are listed below.
Health care fraud, waste and abuse can be committed by health partners, members or pharmacies. Examples include the following.
- 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
- Sell prescribed drugs or try to get controlled drugs from more than one provider or drugstore
- Change or forge prescriptions
- Use pain medications they do not need
- Share their ID card with someone else
- Don’t tell us that they have other health insurance
- Get equipment and supplies they don’t need
- Get care or drugs under some other person’s ID
- 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?
- • Call 1-844-415-1272. Select the menu choice to report fraud. Our Fraud, Waste, and Abuse hotline is available 24 hours a day.
- Calling the Member Services number below and following the prompts for fraud. Our Fraud, Waste, and Abuse hotline is available 24 hours a day.
- Completing the Fraud, Waste and Abuse Reporting Form and mailing it to:
- 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. If you are not worried about giving your name, you may also send an email* to firstname.lastname@example.org or fax us at 1-800-418-0248. 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.
- Fax: 1-800-418-0248
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.
You may also report fraud, waste or abuse directly to the state of Ohio by using one of the methods below:
- Ohio Department of Medicaid (ODM) – 1-614-466-0722
- Medicaid Fraud Control Unit (Mfcu) – 1-800-282-0515
- The Ohio Auditor Of State (AOS) – 1-866-Fraud-OH or by email at Fraudohio@Ohioauditor.Gov
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.
- Beware of any offers for free services or items (food, gas, gift cards, etc.) 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.
- Read any papers you receive from CareSource. Read your Explanation of Benefit (EOB) statements and any papers you receive from 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 CareSource keep fraud, waste and abuse out of health care.
Member Services: 1-800-488-0134 (TTY: 1-800-750-0750 or 711), Monday – Friday 7 a.m. – 8 p.m.