How do I report someone who is misusing the Program?

If you suspect a person who receives benefits or a Provider (doctor, dentist, counselor, etc.) has committed waste, abuse or fraud, you have a responsibility and a right to report it.

Reporting Waste, Abuse or Fraud by a Provider or Client

You can report any Providers or clients you suspect of waste, abuse, or fraud directly to Community:

Community Health Choice
Chief Compliance & Quality Officer
2636 South Loop West, Suite 125
Houston, TX 77054

You can also call the Office of Inspector General Fraud Hotline at 1-800-252-3439 or send a note or letter to the following addresses:

Texas Department of Insurance Fraud Unit
P.O. Box 149336
Mail Code 109-3A
Austin, TX. 78714-9336

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:

  • 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