CareChoice Anti-Fraud Measures & Compliance Commitment

CareChoice is fully committed to preventing, detecting, and reporting fraud, waste, and abuse in all Medicaid-funded services. We maintain a comprehensive compliance and oversight framework designed to ensure that all services billed are authorized, properly documented, and actually delivered.

Our Anti-Fraud Measures Include:

Strict EVV Compliance
All caregivers are required to use approved Electronic Visit Verification (EVV) systems to document the start time, end time, and location of services. EVV compliance is actively monitored, and any exceptions are limited, reviewed, and documented in accordance with Medicaid and Managed Care Organization (MCO) requirements.

Care Plan Task Documentation After Every Visit
As part of our EVV and timesheet policies, caregivers are required to document care plan tasks completed after each visit. This ensures that services provided align with the authorized plan of care and supports accurate, transparent billing.

Supervisory Visits & In-Home Verification
CareChoice conducts in-home supervisory visits:

Within the first 30 days of the start of care, and
At least every 90 days thereafter

These visits are conducted to verify that:

The caregiver is present and providing care as authorized
Services are delivered in accordance with the client’s care plan
Documentation accurately reflects services rendered

All supervisory visits are documented and reviewed as part of our ongoing quality assurance and compliance efforts.

Proper Billing Practices
CareChoice does not submit claims unless proper documentation has been received and validated. This includes:

Verified EVV records, or
Approved timesheets in limited and allowable circumstances

Claims undergo internal review prior to submission to ensure accuracy, completeness, and compliance with Medicaid and MCO billing rules.

Post-Billing Review & Claim Voiding
If a claim is identified after submission as incorrect—due to hospitalization, client absence, documentation discrepancies, or services not rendered—the claim is promptly manually voided or adjusted in accordance with payer requirements.

Caregiver Accountability
Caregivers receive ongoing training on compliance expectations, accurate documentation, EVV usage, and fraud prevention. Any payments made for services later determined not to have been properly rendered or documented may be subject to recoupment.

Ongoing Training & Internal Monitoring
CareChoice provides regular fraud, waste, and abuse (FWA) training to caregivers, supervisory staff, and billing personnel. We conduct internal audits, documentation reviews, and data monitoring to identify irregularities or potential compliance risks.

Mandatory Reporting of Fraud, Waste, and Abuse
Any identified or suspected fraud, waste, or abuse is reported promptly to the appropriate Managed Care Organization (MCO), State Medicaid Agency, and the Office of Inspector General (OIG), in accordance with all applicable laws and regulations.

Our Commitment

CareChoice maintains a zero-tolerance policy for fraud, waste, and abuse. We are committed to ethical operations, regulatory compliance, and the responsible stewardship of public funds while delivering high-quality care to the individuals and families we serve.

CareChoice Anti-Fraud Measures & Compliance Commitment

Our Anti-Fraud Measures Include:

Care Plan Task Documentation After Every Visit As part of our EVV and timesheet policies, caregivers are required to document care plan tasks completed after each visit. This ensures that services provided align with the authorized plan of care and supports accurate, transparent billing.

Supervisory Visits & In-Home Verification CareChoice conducts in-home supervisory visits:

Proper Billing Practices CareChoice does not submit claims unless proper documentation has been received and validated. This includes:

Post-Billing Review & Claim Voiding If a claim is identified after submission as incorrect—due to hospitalization, client absence, documentation discrepancies, or services not rendered—the claim is promptly manually voided or adjusted in accordance with payer requirements.

Caregiver Accountability Caregivers receive ongoing training on compliance expectations, accurate documentation, EVV usage, and fraud prevention. Any payments made for services later determined not to have been properly rendered or documented may be subject to recoupment.

Ongoing Training & Internal Monitoring CareChoice provides regular fraud, waste, and abuse (FWA) training to caregivers, supervisory staff, and billing personnel. We conduct internal audits, documentation reviews, and data monitoring to identify irregularities or potential compliance risks.

Mandatory Reporting of Fraud, Waste, and Abuse Any identified or suspected fraud, waste, or abuse is reported promptly to the appropriate Managed Care Organization (MCO), State Medicaid Agency, and the Office of Inspector General (OIG), in accordance with all applicable laws and regulations.