Reporting Waste, Fraud and Abuse

Do you want to report Medicaid Waste, Abuse, or Fraud?

Let us know if you think a doctor, dentist, pharmacist at a drug store, other health care providers, or a person getting Medicaid benefits is doing something wrong. Doing something wrong could be waste, abuse, or fraud, which is against the law. For example, tell us if you think someone is:

  • Getting paid for Medicaid services that weren’t given or necessary.
  • Not telling the truth about a medical condition to get medical treatment.
  • Letting someone else use their Medicaid ID.
  • Using someone else’s Medicaid ID.
  • Not telling the truth about the amount of money or resources he or she has to get benefits.

 

Do you want to report CHIP Waste, Abuse, or Fraud?

Let us know if you think a doctor, dentist, pharmacist at a drug store, other health-care provider, or a person getting CHIP benefits is doing something wrong. Doing something wrong could be waste, abuse, or fraud, which is against the law. For example, tell us if you think someone is:

  • Getting paid for CHIP services that weren’t given or necessary.
  • Not telling the truth about a medical condition to get medical treatment.
  • Letting someone else use a CHIP ID.
  • Using someone else’s CHIP ID.
  • Not telling the truth about the amount of money or resources he or she has to get benefits.

To report waste, abuse, or fraud, choose one of the following:

  • Call the OIG Hotline at 1.800.436.6184;
  • Visit https://oig.hhsc.state.tx.us/ and click the red “Report Fraud” box to complete the online form; or
  • You can report directly to your health plan:
    Community Health Choice Texas, Inc.
    Vice President/Corporate Compliance & Risk Management
    2636 South Loop West, Suite 125
    Houston, TX 77054
    Toll-free at 1.877.888.0002

To report waste, abuse or fraud, gather as much information as possible:

When reporting a Provider (doctor, dentist, counselor, etc.), include:

  • Name, address, and phone number of Provider
  • Name and address of the facility (hospital, nursing home, home health agency, etc.)
  • Medicaid number of the Provider and facility, if you have it
  • Type of Provider (doctor, dentist, therapist, pharmacist, etc.)
  • Names and phone numbers of other witnesses who can help in the investigation
  • Dates of events
  • Summary of what happened

When reporting about someone who receives benefits include:

  • The person’s name
  • The person’s date of birth, Social Security Number, or case number if you have it
  • The city where the person lives
  • Specific details about the waste, abuse or fraud