Fraud, Waste & Abuse

What Does Fraud, Waste and Abuse Look Like?

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 Program Integrity.

Cases of provider fraud, waste and abuse are health workers and doctors 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

Cases of member fraud, waste and abuse are:

  • Sharing your CareSource member ID card with another person
  • Selling prescribed drugs or other medical equipment paid for by CareSource to others
  • Providing inaccurate symptoms and other information to health partners to get treatment or drugs

Cases of pharmacy fraud, waste and abuse are:

  • 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

If You Suspect Fraud, Waste Or Abuse

If you think someone is committing fraud, waste or abuse, you must let us know.

You can tell us in one of these ways:

  • Call: 1-844-607-2829 (TTY: 1-800-743-3333 or 711)
  • Web: Go to CareSource.com/Indiana . Click on Tools and Resources, then Forms and fill out the form.
  • Mail: CareSource, Attn: Program Integrity Department, P.O. Box 1940, Dayton, OH 45401-1940
  • Email: fraud@caresource.com
  • Fax: 1-800-418-0248

Please share as much as you can when you alert us about fraud, waste or abuse. Give us names and phone numbers if you know them. You do not have to give your name. We will not be able to call you back for more information if you choose not to give us your name. Your report will not be shared unless required by law.

*Most email is not protected from third parties. This means people may get your email without you knowing or saying it is okay. Please do not use email to tell us things that you think should be kept private. Don’t send us your member ID number, social security number or health information through email. Please use the form or the phone number above.

Thank you for helping us keep fraud, waste and abuse out of health care!

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.

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

Member Services: 1-844-607-2829 (TTY: 1-800-743-3333), 8 a.m. to 8 p.m., Monday – Friday Eastern Time