Fraud, Waste, and Abuse
Absolute Total Care is committed to preventing, detecting, identifying, and reporting suspected cases of fraud, waste, and abuse.
That's why we have Fraud, Waste, and Abuse (FWA) Program that complies with all state and federal laws. Absolute Total Care , in conjunction with its management company, Centene Corporation, successfully operates a Payment Integrity Department (PI) and a Special Investigations Unit (SIU). Absolute Total Care routinely conducts audits to ensure compliance with billing regulations.
Our sophisticated code editing software performs systematic audits during the claims payment process. To better understand this system, please review our Provider Manuals, located on the Provider Manuals and Forms webpage. The SIU performs retrospective audits which, in some cases, may result in taking actions against providers who commit fraud, waste, and and/or abuse.
These actions include, but are not limited to:
- Remedial education and training to prevent the billing irregularity
- More stringent utilization review
- Recoupment of previously paid monies
- Termination of provider agreement or other contractual arrangement
- Civil and/or criminal prosecution
- Any other remedies available to rectify
Some of the most common errors seen are:
- Unbundling of codes
- Up-coding services
- Add-on codes without primary CPT
- Diagnosis and/or procedure code not consistent with the member’s age/gender
- Use of exclusion codes
- Excessive use of units
- Misuse of benefits
- Claims for services not rendered
If you suspect or witness a provider inappropriately billing or a member receiving inappropriate services, please call our anonymous and confidential hotline at 1-866-685-8664. Absolute Total Care takes all reports of potential fraud, waste, and abuse very seriously and will investigate all reported issues
Reporting Fraud, Waste, and Abuse
Absolute Total Care fraud, waste, and abuse reporting contact information:
Absolute Total Care’s staff is available to answer any questions or concerns you have regarding fraud, waste, and abuse issues.
Absolute Total Care
Attn: Compliance Department
1441 Main Street, Suite 900
Columbia, SC 29201
Absolute Total Care Fraud, Waste, and Abuse Hotline: 1-866-685-8664 (All calls are confidential.)
South Carolina Department of Health and Human Services (SCDHHS) fraud, waste, and abuse reporting contact information:
SCDHHS Division of Program Integrity
P.O. Box 8206
Columbia, SC 29202