Fraud & Abuse

Fraud & Abuse

Reporting Waste, Fraud, and Abuse

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 or illegal. Read below to find out what this means and how to report it.

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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.

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:

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 

CHIP 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

Additional Contact Numbers

CHIP 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

Additional Contact Numbers

Why Choose Community?

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.

“I always tell people to choose Community Health Choice. I tell them it’s the best health insurance they will ever be with.”

– Chandolyn
Member of Community Health Choice