Corporate Compliance
The importance of integrity, ethics, and compliance is emphasized among Common Ground Healthcare Cooperative (CGHC) employees and is reinforced through our Compliance Program and Compliance and Integrity Code of Conduct.
Click here to visit the CareSource Corporate Compliance web page to review each of our documents.
Fraud, Waste & Abuse
CGHC has a program designed to handle cases of health care fraud. We monitor and take action on any member or provider fraud, waste and abuse. Some examples are:
Provider Fraud, Waste and Abuse
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- Prescribing drugs, equipment or services that are not medically necessary
- Scheduling more frequent return visits than are medically necessary
- Billing for tests or services not provided to a member
- Billing for more expensive services than provided
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Member Fraud, Waste and Abuse
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- Misusing a CGHC ID card or sharing it with another person
- Selling prescribed drugs or other medical equipment paid for by CGHC to others
- Submitting false information
- Forging a doctor’s signature on prescriptions or other documents
- Providing inaccurate symptoms and other information to providers to get treatment, drugs, etc.
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Pharmacy Fraud, Waste and Abuse
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- Providing drugs that are not according to the prescription
- Providing a generic drug then sending in a claim for a more expensive brand-name drug
- Giving a member less than the prescribed drug amount without telling the member and without giving the rest of the amount the member should receive
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Do You Suspect Fraud, Waste or Abuse?
If you think a provider or a CGHC member is committing fraud, waste or abuse, you can report your concerns to us by:
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- Calling the Fraud, Waste and Abuse hotline at 1-844-415-1272. The hotline is available 24 hours a day.
- Completing the Fraud, Waste and Abuse Reporting Form
- Sending us a letter addressed to:
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CGHC/CareSource
Attn: Program Integrity
P.O. Box 1940
Dayton, OH 45401-1940
You do not have to give us your name when you write or call. However, if you choose to remain anonymous, we will not be able to call you back for more information.
If you are not concerned about giving your name (remaining anonymous), you may also use one of the following methods to contact us:
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- Email: fraud@caresource.com
- Fax: 1-800-418-0248
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When you report fraud, waste or abuse, please give us detailed information that includes a clear description of what you believe has happened. Also, if you have the names and phone numbers of those involved, please include them. Please leave as many details as possible. Your report will be kept confidential to the extent permitted by law. Remember, if you choose to remain anonymous, we will not be able to get in touch with you for more information.
How Can Members Protect Against Fraud?
Below are a few simple tips to help members protect against health care fraud:
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- Treat your member ID card like you would a credit card. Don’t give out your policy number over the phone or on the internet unless you initiated the interaction with us or your health care provider. Also, do not provide your policy number to door-to-door salespeople. 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 a CGHC 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.
- Read your Explanation of Benefit (EOB) statements and any papers you receive from CGHC. Here are some warning signs to look for:
- Services, supplies or equipment listed that you did not receive
- Any services that were billed more than once but you received only once
- Did you get services on all the dates of service that are shown?
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If you suspect an error or fraud, report it to CGHC using one of the methods above.
Thank you for helping CGHC keep fraud, waste and abuse out of health care.