Fraud, Waste & Abuse

As an FMO, CareValue is committed to detecting, preventing, and correcting healthcare fraud, waste and abuse because it affects everyone.  CareValue wants to make sure you know what it is, how to spot it, and how to help us prevent it.

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Auditing and Monitoring of Systems and a Method of Anonymous Reporting

Care Value, LLC. maintains auditing and monitoring of its systems to detect violations of the law and to evaluate the effectiveness of the compliance program. These types of reviews permit the Corporate Compliance Department to evaluate compliance with regulations, policies and procedures. Through these reviews, we are continuously assessing the effectiveness of the compliance program and finding ways to improve it. Employees are expected to assist in responding to routine internal and external audits as well as compliance office investigations.

Reporting Wrongdoing

Care Value, LLC. employees are obligated to report any knowledge of suspected wrongdoing. All reports of wrongdoing are taken seriously. Suspected wrongdoing may be reported to:

  • The immediate supervisor/manager/director/officer
  • The Compliance officer via
  • Human resources at any time and during exit interview
  • The carrier
  • Online anonymously using Report an Incident

Care Value, LLC. employees may also report any knowledge of suspected wrongdoing to state or federal government with jurisdiction over the area of perceived wrongdoing. Reporting may be done in a manner consistent with the Care Value, LLC. policies and procedures addressing reporting options, as amended from time to time.

Protection of Employee

Employees reporting suspected wrongdoing to Care Value, LLC., or to a state or federal government agency, will receive protection from retaliatory workplace actions, consistent with protections more fully described in the Care Value, LLC. policies and procedures addressing reporting options, as amended from time to time.

All reports of suspected wrongdoing are investigated promptly and confidentially to the extent possible. Employees are expected to cooperate with investigation efforts.

Response and Prevention

If a reported allegation is substantiated, or if a violation is discovered as a result of auditing, monitoring or other source:

  • the organization will initiate appropriate action, including, if indicated, making prompt restitution of any overpayment amounts;
  • the appropriate governmental agency will be notified, if necessary;
  • disciplinary action will be implemented, if appropriate; and
  • changes will be implemented to prevent or minimize the likelihood of a recurrence.

To learn more, go to: Medicare Fraud & Abuse: Prevent, Detect, Report
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