Total 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
- 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
- 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 someone of committing insurance fraud against Total Care or think you may be a victim, please report the suspicious activity to the Special Investigations Unit (SIU) at:
Fraud, Waste and Abuse Hotline: 1-800-388-1563
Attn: Fraud, Waste & Abuse Department
819 South Salina Street
Syracuse, NY 13202
New York State Medicaid Inspector General
All communications are confidential and may be anonymous
Total Care offered by Today’s Options® of New York, a member of the Universal American family of companies.