...CareSource business. The Federal False Claims Act Using the False Claims Act (the Act), you can help reduce fraud against the federal government. The Act allows everyday people to bring...

...federal and/or state provider agreements from knowingly having relationships with persons who are debarred, suspended or otherwise excluded from participating in federal procurement and non-procurement activities. Relationships must be terminated...

...and meets regulatory and accrediting agency compliance, including: All federal requirements as outlined in 42 CFR Part 438, Managed Care Healthcare Effectiveness Data and Information Set (HEDIS®) compliance audits and...

...would otherwise be entitled. Federally Recognized Tribes If you are a member of a federally recognized tribe and your household income is at or below 300% of the federal poverty...

...federal and state guidance. We will keep you informed of any changes that could affect your health care coverage. COVID-19 Public Health Emergency Guidance COVID-19 Public Health Emergency Guidance Health...

...dosing, patient safety, applicable state and federal laws, or the Food & Drug Administration (FDA) recommendations. Step Therapy Sometimes, CareSource will require a member to try a less expensive drug...

...Suicide Initiative is a commitment to suicide prevention in health and behavioral health care systems. Suicide Prevention Resource Center– The Suicide Prevention Resource Center (SPRC) is the nation’s only federally...

...meet the requirements of all applicable state and federal laws and regulations as they pertain to provision of services and care. CareSource prohibits its providers or partners from refusing to...

...rendered Retaining payments made in error by CareSource Payments stemming from kickbacks or Federal Stark Law violations Duplicate payments for services Member: Inappropriate use of Medicaid/Medicare purchased narcotics Forging prescriptions...

...a physician’s medical judgment about individual patients. CareSource of North Carolina Co. defaults to all applicable state and federal guidelines regarding criteria for authorization of covered services. CareSource of North...