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Fraud and Abuse

Protect yourself, and our members, against fraud and abuse

Robert Snoddy, manager of Audit and Compliance, has been at CareOregon for seven years.  Prior to coming here, Robert gained valuable administrative and operational experience working in the transportation industry.  In his off time, he enjoys being with his two Italian Greyhounds, Darci and Dori, and attending music performances.

Can you guess how much health care fraud costs taxpayers each year? Millions? Billions?
Keep in mind that, in the U.S., more than four billion health insurance claims are processed in the U.S. every year, and more than two trillion dollars is spent on health care services.

The Center for Health Transformation has the answer. It estimates that financial losses from Medicare and Medicaid fraud amounts to approximately $100 billion annually. 

Does that matter to you? It does, at least in two ways.

If employees are found to have committed health care fraud (intentionally breaking the law) or abuse (not compliant with sound business practices), they can be disciplined, up to and including dismissal, as well as be subject to prosecution.

Medicaid and Medicare fraud and abuse also hurts those we serve, because it increases medical costs and reduces funds going to low-income and disabled citizens needing health services – including the members of CareOregon Advantage and OHP members of our partner CCOs.

To help prevent fraud and abuse when you are the recipient of health services:

Protect your health insurance card like you would a credit card. Be careful about disclosing your insurance information, and if you lose your insurance ID card report it to your insurance company immediately.

Be informed about the health services you receive, keep good records of your care, and closely review all your medical bills. If you see something that doesn't look right, report the situation to your health plan right away. 

Beware of “free” offers of health services, tests or treatments. They often are fraud schemes designed to bill you and your insurance company for treatment you never received.

If you suspect non-compliance, fraud or abuse (including possible medical identity theft), please contact CareOregon’s Audit and Compliance Department. You also can file a report at, or call EthicsPoint, our 24-hour anonymous reporting fraud hotline at 1-888-331-6524.