Fraud

Fraud Awareness
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

Member Fraud

  • 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

Provider Fraud

  • 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
Email: fraud@UniversalAmerican.com

In writing:

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
1-877-87FRAUD (1-877-873-7283)

All communications are confidential and may be anonymous.

  • text size :  
  • A
  • A
  • A