Report Fraud, Waste and Abuse

Home State Health takes the detection, investigation, and prosecution of fraud and abuse very seriously, and has a fraud, waste, and abuse (FWA) program that complies with the State of Missouri and federal laws. Home State Health, in conjunction with its parent company, Centene, operates a fraud, waste, and abuse unit. Home State 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 the Billing and Claims provider manual. The Centene Special Investigation Unit (SIU) performs retrospective audits which, in some cases, may result in taking actions against providers who commit fraud, waste, 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 FWA practices include:

Unbundling of codes
Up-coding services
Add-on codes billed without primary CPT
Use of exclusion codes
Excessive use of units
Misuse of Benefits
Claims for services not rendered

If you suspect or witness a provider inappropriately billing or a member receiving inappropriate services, please call our anonymous and confidential FWA hotline at 1-866-685-8664 to report your concerns. You may also call the following to report fraud and abuse concerns:

Missouri Department of Social Services
- Division of Legal Services, Investigation Unit: 1-573-751-3285 or MMAC.reportfraud@dss.mo.gov
- MO HealthNet Division Constituent Services: 1-800-392-2161
Missouri Attorney General Office Medicaid Fraud Control Unit (MFCU) : 1-800-286-3932
Health and Human Services - Office of Inspector General (OIG) Hotline: 1-800-HHS-TIPS (447-8477)