Waste, Fraud or Abuse

fraud_abuse

Waste, Fraud or Abuse

How do I report someone who is misusing the program?

Report a case. 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 Texas, Inc.
Chief Compliance & Quality Officer
2636 South Loop West, Suite 125 
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 HHSC Office of Inspector General Fraud Hotline at 1.800.436.6184. You also can send a note or letter to the following addresses:

To report Providers, use this address:

Office of Inspector General
Medicaid Provider Integrity/Mail Code 1361
P.O. Box 85200
Austin, TX 78708-5200

To report clients, use this address:

Office of Inspector General
General Investigations/Mail Code 1362
P.O. Box 85200
Austin, TX 78708-5200

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

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.

Community Health Choice is one of the greatest companies that I know. This program gives me hope in our Community.