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 directly to your health plan any Providers or clients you suspect of waste, abuse, or fraud:

Community Health Choice, Inc.
Vice President/Compliance
2636 South Loop West, Suite 900
Houston, TX 77054
1-877-888-0002

Or if you can get on the Internet, go to www.hhsc.state.tx.us and select the “Reporting Waste, Abuse and Fraud” tab on the left side of the screen. The site tells you about the types of waste, abuse and fraud to report. If you cannot get on the Internet and you would rather talk to a person, call the Office of Inspector General Fraud Hotline at 1-800-252-3439. You also can 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
www.tdi.texas.gov

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