Fraud, Waste & Abuse

Addressing Fraud, Waste, and Abuse

Care N’ Care Insurance Company of North Carolina, Inc. d/b/a HealthTeam Advantage is committed to detecting, correcting, and preventing fraud, waste and abuse.  Doing this is a vital component of our compliance and integrity plan.

What are Fraud, Waste and Abuse?

  • Fraud: Knowingly and willfully executing, or attempting to execute, a scheme or artifice to defraud any health care benefit program or to obtain (by means of false or fraudulent pretenses, representations, or promises) any of the money or property owned by, or under the custody or control of, any health care benefit program. 18 U.S.C. § 1347.
  • Waste: Waste is the overutilization of services, or other practices that, directly or indirectly, result in unnecessary costs to the Medicare program. Waste is generally not considered to be caused by criminally negligent actions but rather the misuse of resources.
  • Abuse: Abuse includes actions that may, directly or indirectly, result in: unnecessary costs to the Medicare Program, improper payment, payment for services that fail to meet professionally recognized standards of care, or services that are medically unnecessary. Abuse involves payment for items or services when there is no legal entitlement to that payment and the provider has not knowingly and/or intentionally misrepresented facts to obtain payment.

Fraud, Waste, and Abuse Training

HealthTeam Advantage has adopted the training published by the Centers for Medicare & Medicaid Services (CMS).  This training is required of HealthTeam Advantage employees, members of the board of directors, and business partners.  This training may be accessed through the following link:  CMS Required Training

How to Report Fraud, Waste, and Abuse

If you suspect fraud, waste, or abuse has occurred, we encourage you to report it to HealthTeam Advantage’s Compliance and Integrity Office, and can do so anonymously and without fear of reprisal, or retaliation.  We will investigate and take appropriate action as necessary.