Fraud, Waste and Abuse

Absolute Total Care is committed to preventing, detecting, identifying and reporting suspected cases of fraud, waste and abuse, and has a 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 the Billing and Claims chapter of the Provider Manual. 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 (ATC) Fraud, Waste & Abuse reporting contact information:

Mail:
Absolute Total Care
Compliance Department
1441 Main Street, Suite 900
Columbia, SC 29201

Phone: Absolute Total Care Fraud and Abuse Hotline 1-866-685-8664 (all calls are confidential)

Email: ATC.Compliance@centene.com

South Carolina Department of Health and Human Services (SCDHHS) Fraud, Waste & Abuse reporting contact information:

Mail:
SCDHHS Division of Program Integrity
P.O. Box 8206
Columbia, SC 29202

Phone: 1-888-364-3224

Email: fraudres@scdhhs.gov

Absolute Total Care’s staff is available to answer any questions or concerns you have regarding fraud, waste and abuse issues.  Please contact Absolute Total Care’s Provider Services Department at 1-866-433-6041 with any questions.

Medicaid Fraud Letter
Medicare-Medicaid Plan (MMP) Fraud Letter