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.
HealthTeam Advantage, a product of Care N’ Care Insurance Company of North Carolina, Inc., is a Medicare Advantage plan with a Medicare contract. Enrollment in HealthTeam Advantage depends on contract renewal. This information is not a complete description of benefits. Call for more information: prospective members call 877-905-9216 , HTA PPO members call 888-965-1965, and HTA CSNP members call 833-324-3242 (TTY:711) from October 1–March 31, 8 a.m. to 8 p.m. ET, seven days a week, or April 1–September 30, 8 a.m. to 8 p.m. ET, Monday through Friday. Medicare beneficiaries may also enroll in HealthTeam Advantage through the CMS Medicare Online Enrollment Center located at http://medicare.gov. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or copayments/coinsurance may change on January 1 of each year. The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.
Every year, Medicare evaluates plans based on a 5-star rating system.