Policies & Procedures
Page last updated: October 01, 2023
© Copyright 2023 – Care N’ Care – All rights reserved. Y0107_24_114_M
Care N’ Care is committed to detecting and fighting healthcare fraud, waste and abuse. Care N’ Care evaluates all allegations of fraud, waste and abuse and works with law enforcement, when necessary,
You can help us fight fraud by paying close attention to your medical and prescription drug benefits. Review every Explanation of Benefits (EOB) for accuracy. If you find a suspicious charge on your EOB or Medicare Summary Notice, call your provider first. It could be a simple error that can be easily corrected. If you still suspect fraud after speaking with them, you can contact Care N’ Care at 1-877-374-7993 (TTY 711). Care N’ Care employees are trained in detecting fraud, waste and abuse and will evaluate your call and determine the appropriate course of action. To report healthcare fraud, waste, or abuse, call the Care N’ Care Compliance and Fraud Hotline at 1-844-760-5838 or email cnc_swhr_siu@southwesternhealth.org. Reports made through the hotline can be made confidentially or anonymously, 24 hours a day, 7 days a week. To submit a written report, write to: Care N’ Care, Attn: Compliance Department, 1603 Lyndon B. Johnson Freeway, Suite 300, Farmers Branch, TX 75234.
You can also contact the Office of the Inspector General Hotline; this provides a confidential means to report information.
Examples of potentially fraudulent activities:
- You did not receive a medication or service listed on your EOB.
- You received a different drug or service than what is listed on your EOB.
- You received a different quantity of drug than what is listed on your EOB.
- Someone asked you to sell your member ID card.
- Someone asked you to use your member ID card.
- Someone offered you cash to purchase a prescription drug or to disenroll from your current plan.
Ways to protect yourself from fraud:
- Keep your personal and health insurance information secure.
- Review your EOBs and Medicare Summary Notices for accuracy and report inconsistencies.
- Be wary of “free” services that require you to provide your Social Security Number or health insurance information.
- Report waived co-payments and deductibles.
Care N’ Care materials are available in other formats, call toll-free at 1-800-994-1076 (TTY 711) October 1– March 31, 8 am – 8 pm, (CST) seven days a week or April 1 – September 30, 8 am – 8 pm (CST), Monday through Friday.
© Copyright 2023 – Care N’ Care – All rights reserved. Y0107_24_114_M
