Fraud, Waste, or 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 fraud, waste, or abuse, you have a responsibility and a right to report it.

Reporting Fraud, Waste, or Abuse by a Provider or Client

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

Community Health Choice
Chief Compliance Officer
2636 South Loop West, Suite 125
Houston, TX 77054
1.877.888.0002

Internal Compliance:

Web Site: https://www.reportlineweb.com/chc
Telephone Hotline: 877.888.0002

Fax: 770.409.5008

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 fraud, waste, or abuse, 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 fraud, waste, or abuse

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.