What is Fraud and Abuse?
Fraud is the intentional deception or misrepresentation of facts, knowing that the deception could result in unauthorized benefit or payment.
Abuse is an action inconsistent with sound fiscal, business or medical practice that results in an unnecessary cost to Renaissance or TennCare or in reimbursement for medically unnecessary services. Abuse includes violations of an agreement or certificate of coverage or failure to meet professionally recognized standards of health care.
What can you do?
- Treat your health benefits identification like a credit card.
- Protect yourself from identity theft.
- Look carefully at each Explanation of Benefits (EOB). You can find those in the Member Portal.
- After you’ve visited a dentist’s office, EOBs can be accessed in the member portal. Make sure you had the visit or service on the date stated on the EOB. If you have questions about the EOB, please call customer service at 866-864-2526.
Report Fraud and Abuse
If you suspect someone of fraud or abuse, please contact us immediately. You may remain anonymous.
- Call our anti-fraud hotline at 800-971-4139.
- Complete and submit this form. Please provide a detailed account of the incident or service(s).
