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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
    • 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)