Help us prevent fraud, waste, and abuse!
Community Health Choice has a team that works hard to identify and prevent fraud, waste, and abuse. If you see it, report it.
Community Health Choice has a team that works hard to identify and prevent fraud, waste, and abuse. If you see it, report it.
FraudĀ means an intentional deception or misrepresentation made by a person with the knowledge that the deception could result in some unauthorized benefit to himself or some other person. It includes any act that constitutes fraud under applicable federal or state law (42 C.F.R. Ā§ 455.2).
WasteĀ means an overutilization of services or other practices that directly or indirectly result in unnecessary costs. Waste is generally not considered to be caused by criminally negligent actions, but rather the misuse of resources.
AbuseĀ means provider practices that are inconsistent with sound fiscal, business, or medical practices, and result in an unnecessary cost to the Medicaid program, or in reimbursement for services that are not medically necessary or that fail to meet professionally recognized standards for health care. It also includes beneficiary practices that result in unnecessary cost to the Medicaid program (42 C.F.R. Ā§455.2).
The cost of FWA was more than $68 billion annually, according to the National Health Care Anti-Fraud Association (NHCAA). That cost affects both health plan members and health care providers.
Healthcare fraud is a crime addressed by both state and federal laws.
For example, the federal Health Care Fraud Statute (18 U.S.C. Ā§ 1347) makes it a criminal offense to knowingly and willfully execute a scheme to defraud a health care benefit program, such as Medicaid. Health care fraud is punishable by imprisonment for up to 10 years. It is also subject to criminal fines of up to $250,000.
Protect yourself. Do not:
Community Health Choice has a team that works hard to identify and prevent FWA, but we need your help.
Phone:
FWA Hotline atĀ 1.877.888.0002
Mail:
Special Investigations Unit
4888 Loop Central Dr. Suite 600
Houston, TX 77081
E-mail:
S[email protected]
Online:
Secure contact form
You may also report suspected fraud, waste, and abuse to the Texas Health and Human Services program.
Phone:
FWA Hotline atĀ 1.800.436.6184
CHIPĀ Member Services
Local: 713.295.2294 | Toll-Free: 1.888.760.2600
Monday through Friday (excluding State-approved holidays) 8:00 a.m. to 6:00 p.m
General Information
Local: 713.295.2222 | Toll-Free: 1.877.635.6736
Monday through Friday (excluding State-approved holidays) 8:00 a.m. to 6:00 p.m.
Providers Hotline
Local: 713.295.2295
Monday through Friday (excluding State-approved holidays) 8:00 a.m. to 5:00 p.m
CHIPĀ Member Services
Local: 713.295.2294 | Toll-Free: 1.888.760.2600
Monday through Friday (excluding State-approved holidays) 8:00 a.m. to 6:00 p.m
General Information
Local: 713.295.2222 | Toll-Free: 1.877.635.6736
Monday through Friday (excluding State-approved holidays) 8:00 a.m. to 6:00 p.m.
Providers Hotline
Local: 713.295.2295
Monday through Friday (excluding State-approved holidays) 8:00 a.m. to 5:00 p.m
As a local nonprofit health plan, Community Health Choice gives you plenty of reasons to join our Community. From the benefits and special programs we offer to the way our Member Services team helps you make the most of them, Community is always working life forward for you and your family.
āCommunity Health Choice is always there to answer my questions and help me and my family with our medical needs. I truly appreciate and value their customer support and service.ā
ā Cecily
Member of Community Health Choice