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Report Fraud, Waste and Abuse

Nebraska Total Care takes the detection, investigation, and prosecution of fraud and abuse very seriously, and has a fraud, waste, and abuse program that complies with the State of Nebraska and federal laws.

Heritage Health - Nebraska Total Care 

Nebraska Total Care, in conjunction with its parent company, Centene, operates a fraud, waste, and abuse unit. Nebraska Total Care 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 performs retrospective audits which, in some cases, may result in taking actions against providers who commit waste, abuse, and/or fraud.

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
  • Unannounced Onsite Audit Investigations
  • Nebraska Total Care will notify DHHS Program Integrity of all provider audits

Some of the most common FWA practices include:

  • Unbundling of codes
  • Up-coding services
  • Add-on codes billed without primary CPT
  • Diagnosis and/or procedure code not consistent with the member’s age/gender
  • Use of exclusion codes
  • Excessive use of units
  • Misuse of Benefits
  • Claims for services not rendered

Potential Fraud, Waste or Abuse should be reported to Nebraska Total Care's anonymous and confidential hotline at 1-866-685-8664 or by contacting the Compliance Officer at 1-844-385-2192 (TTY 711).  You may also send an email to NTC-Compliance@NebraskaTotalCare.com.

How to report suspected Fraud, Waste, and Abuse

To report suspected Fraud, Waste, and Abuse or neglect in the Nebraska Medicaid Program, please use one of the following avenues:

Medicaid Provider Fraud:  Medicaid Fraud and Patient Abuse Unit
(402) 471-3549 or toll-free at 1-800-727-6432
ago.medicaid.fraud@nebraska.gov

Medicaid Provider Self-Disclosure:  Nebraska Medicaid Program Integrity
(877) 255-3092
DHHS.MedicaidProgramIntegrity@nebraska.gov
Nebraska Medicaid Program - Program Integrity

Medicaid Client Fraud:  Special Investigation Unit
(402) 595-3789
Investigations.SIU@dhhs.ne.gov

Written Complaints to Lincoln:
DHHS Division of Children and Family Services Investigations
1033 O Street, Suite 500
Lincoln, NE 68508

Written Complaints to Omaha:
DHHS Division of Children and Family Services Investigations
1215 S 42nd Street
Omaha, NE 68105