Total Care, A Today's Options® of New York Health Plan, is committed to detecting, preventing and eliminating fraud and abuse, and to helping Members and Providers identify fraud.
What is Fraud
Fraud is any type of intentional deception or misrepresentation made by a person with the knowledge that the deception could result in some unauthorized benefit.
There are 2 basic types of Fraud: Member and Provider
Providing false information on an application for insurance
Using someone else’s member ID card for medical services
Misuse of services provided by Total Care, A Today's Options® of New York Health Plan (e.g., home healthcare services)
Soliciting or receiving a kickback from a provider
Re-selling items provided by Total Care, A Today's Options® of New York Health Plan or providers
Billing for services not furnished
Misrepresenting the diagnosis to justify higher payment
Soliciting, offering, or receiving a kickback
Falsifying certificates of medical necessity, plans of treatment, and medical records to justify payment
Billing for services not furnished as billed (i.e., Upcoding, Unbundling)
If you suspect someone of committing insurance fraud against Total Care, A Today's Options® of New York Health Plan or think you may be a victim, please report the suspicious activity to the Special Investigations Unit (SIU) at:
Fraud, Waste and Abuse Hotline: 1-800-388-1563
TTY: New York Relay 1-800-662-1220
Total Care, A Today's Options® of New York Health Plan
Attn: Fraud, Waste & Abuse Department
5232 Witz Drive
North Syracuse, New York 13212-6501
New York State Medicaid Inspector General
All communications are confidential and may be anonymous.