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
Absolute Total Care's staff is available to answer any questions or concerns you have regarding fraud, waste and abuse issues.
Reporting Fraud, Waste and Abuse
Potential fraud, waste and abuse reporting may be accomplished by calling Absolute Total Care’s anonymous and confidential hotline at 1-866-685-8664; by contacting our Compliance Officer at 1-866-433-6041; or by emailing atc.complinace@centene.com. You may also report by mail to Absolute Total Care Compliance Department, 100 Center Point Circle, Suite 100, Columbia, SC 29210. Absolute Total Care takes all reports of potential fraud, waste and abuse very seriously and will investigate all reported issues.
To report fraud,waste and abuse in the Medicaid Program, please use one of the following:
The South Carolina Attorney General’s Office: 1-888-662-4328
The South Carolina Department of Health & Human Services Program Integrity Office:
Phone: 1-888-364-3224
Email: fraudres@scdhhs.gov
Mail: SCDHHS Division of Program Integrity
P.O. Box 8206
Columbia, SC 29202