Fraud & Abuse

Reporting Waste, Fraud and Abuse

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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

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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

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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.

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

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

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