| Fraud and abuse Health care billing mistakes happen a lot. The rules that
doctors and hospitals must follow are very tricky. It is no
wonder that billing mistakes happen in a busy doctor’s office or
emergency room.
We know most of the doctors and hospitals want to do what is
right. They want to follow the rules and take care of your
family.
But, there are some people that want something for nothing. You
may have read about hospitals and providers that have cheated
the system. They billed for services they did not do, or worse.
We need your help to stop this.
Texas Children’s Health Plan has been authorized by the State of
Texas to implement a program to identify and prevent fraud,
abuse and waste. These terms mean:
Fraud—Knowingly submitting false claims in order to
receive payment.
Abuse—Taking advantage of loopholes in the law to increase
payments.
Waste—Making excessive payments due to poor training and
education.
Fraud, abuse and waste hurts everyone. It raises taxes. It
reduces funds available to pay benefits. It may even reduce the
quality of care.
Some examples of fraud you might see include:
-
Providers billing for services your family did not receive.
-
Billing for different services than what you received.
-
Asking for your member ID number when you are not going to the
clinic or hospital.
-
Offering money for your member ID number.
- Offering prizes or payments for
you to come to a clinic or hospital.
Be on the lookout for common
scams such as:
To help us prevent fraud, follow
these tips:
Can members commit fraud?
Some members do commit fraud. They might change doctors to feed
a bad habit. They might ask for services they do not need. Or,
they may lie to a doctor. Some may even work with a doctor to
commit fraud in return for money. Member fraud is against the law. Member fraud could result in
losing your benefits. Or worse, it could mean fines or jail.
If you suspect fraud, abuse or waste
What if you suspect fraud? Contact us immediately. Do not wait
more than one day. Texas Children’s Health Plan’s fraud hotline is
832-828-1320.
The fax number is 832-825-8772. You can e-mail us at
TCHPFraudandAbuse@texaschildrenshospital.org.
Or send a letter
to:
Texas Children’s Health Plan
Fraud and Abuse Investigations
Mail Code NB 8302
P.O. Box 301011
Houston, TX 77230-1011 You do not have to give your name. Just tell us why you think
there is fraud. Give us the name of the provider. And, tell us
what you are worried about.
We will take your questions seriously. We will investigate every
case. We may even send your concern to the State. Most often, we
will teach the provider what they did wrong.
Please help us
Texas Children’s Health Plan wants to identify and prevent
fraud. We need, and appreciate, your help! Call us with any
questions.
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