Fraud AwarenessTotal Care is committed to the detection, prevention, and the elimination of fraud and abuse and helping Members and Providers identify fraud.
What is Fraud
Fraud is any type of intentional deception or misrepresentation made by a person with the knowledge that the deception could result in some unauthorized benefit.
There are 2 basic types of Fraud: Member and Provider
Member Fraud
- Providing false information on an application for insurance
- Using someone else’s member ID card for medical services
- Misuse of services provided by Total Care (i.e., Transportation)
- Soliciting or receiving a kickback from a provider
- Re-selling items provided by Total Care or providers
Provider Fraud
- Billing for services not furnished
- Misrepresenting the diagnosis to justify higher payment
- Soliciting, offering, or receiving a kickback
- Falsifying certificates of medical necessity, plans of treatment, and medical records to justify payment
- Billing for services not furnished as billed (i.e., Upcoding, Unbundling)
If you suspect fraud, please call Total Care’s Fraud Hotline:
1-866-705-6386
All calls are confidential
Or Write: Total Care
Attn: Fraud & Abuse Dept
819 South Salina St
P.O. Box 11507
Syracuse, NY 13218-1507
New York State:
Medicaid Inspector General, 1-877-87FRAUD (877-873-7283)
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