Fraud and Abuse
CareSource has a program designed to handle cases of managed care fraud.
Fraud can be committed by providers or members. Examples of provider fraud include doctors or other health care providers who:
- Prescribe drugs, equipment or services that you feel are unnecessary
- Schedule more frequent return visits than you feel are necessary
- Bill for services not provided to you
The following examples are considered member fraud. CareSource monitors these member activities:
- 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 forge their doctor’s signature to receive gift certificates
IF YOU SUSPECT FRAUD
If you think a doctor or a CareSource member is committing fraud, you can:
- Call us at 1-800-488-0134 and select the menu option for reporting fraud, or
- Send an e-mail to fraud@csmg-online.com.
Please leave a detailed message. Include names and phone numbers of those involved, if you have them. You do not have to leave your name. However, if you don’t, we will not be able to call you back for more information. Or complete our Fraud and Abuse reporting form. Your message will be kept confidential whenever possible.