Fraud Awareness

Total Care, A Today's Options® of New York Health Plan 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 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
      TTY: New York Relay 1-800-662-1220
      Email: fraud@UniversalAmerican.com 
      In writing:
                    Total Care, A Today's Options
® of New York Health Plan  
                    Attn: Fraud, Waste & Abuse Department 
                    819 South Salina Street
                    PO BOX 11507
                    Syracuse, NY 13218-1507

N
ew York State Medicaid Inspector General
1-877-87FRAUD (1-877-873-7283)

All communications are confidential and may be anonymous

Total Care, A Today's Options®  of New York Health Plan, is a member of the Universal American family of companies.





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