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Reporting Waste, Fraud and Abuse

How do I report someone who is misusing the CHIP or Medicaid program?

If you suspect a person who receives CHIP or Medicaid 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 Member

You can report any Providers or Members you suspect of waste, abuse, or fraud in several ways.

Directly to Community

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

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

Get on the Internet

Or, if you can get on the Internet, go to http://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.

Talk to a person

If you cannot get onto the Internet and you would rather talk to a person, call the HHSC Office of Inspector General Fraud Hotline at 1-800-436-6184.

Send a note or letter

Also, you 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 (Members), 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 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