FirstCarolinaCare Insurance Company (“FCC”) is committed to maintaining a culture that promotes the prevention, detection and resolution of issues or conduct that fails to adhere to its policies, procedures and Medicare rules and regulations
FCC requests that its employees, Medicare members, First Tier, Downstream and Related Entities (FDRs) and their employees and other vendors promptly report any suspected / actual instances of Fraud, Waste or Abuse (FWA) or any violation of Federal, State or Medicare rules to its Compliance Department.
To assist with this requirement, FCC’s Compliance Department has established a secure Compliance Helpline. This Helpline provides an avenue for callers to report any activity in a confidential manner. All calls to the Compliance Helpline are treated as private and there is no retaliation for any confidential calls made in good faith.
COMPLIANCE HELPLINE: (855) 367- 8184 (toll free)
If you are not comfortable with or unable to make a report via the Compliance Helpline, please send a written report by mail or email to:
Director of Compliance
FirstCarolinaCare Insurance Company
42 Memorial Drive
Pinehurst, NC 28374
Fraud– It is defined by the Center for Medicare and Medicaid Services (CMS) as an intentional deception or misrepresentation made by an individual who knows that the false information reported could result in an unauthorized benefit to himself/herself or another person
Waste– Unintentional overuse or underuse of services that directly or indirectly result in unnecessary costs to the Medicare Program.
Abuse– includes any action(s) that may directly or indirectly result in unnecessary costs to the Medicare Advantage program including improper payment, payment for services not rendered, and payment for services that fail to meet professionally recognized standardized standards of care or services that are medically unnecessary.
Common types of fraudulent Medicare schemes include but are not limited to:
Sales Agents/Broker Fraud
Health Plan Fraud