Fraud, Waste and Abuse Prevention
Texas Children’s Health Plan has a fraud, waste and abuse plan that complies with state and federal law. It is your responsibility as a participating provider to report any member or provider suspected of potential fraud, waste or abuse. All reports will remain confidential.
Let us know if you think a doctor, dentist, pharmacy, and/or a member is committing potential fraud, waste and/or abuse. Potential fraud, waste and abuse examples include but are not limited to:
- Being paid for services that were not given or necessary.
- Not telling the truth about a medical condition to receive medical treatment.
- Letting someone else use a Medicaid (STAR) or CHIP ID.
- Using someone else’s Medicaid (STAR) or CHIP ID.
- Not telling the truth about the amount of money or resources he or she has to get benefits.
- Intentional misrepresentation made to receive payments or benefits.
- Overuse or misuse of services that are inconsistent with sound medical, business or fiscal practices.
- Extravagant, careless or needless expenditure of government funds.
To report waste, abuse or fraud, choose one of the following:
- Call the OIG Hotline at 1-800-436-6184 • Visit https://oig.hhs.texas.gov/ Click on the red box at the top right of the screen labeled “Report Fraud” to complete the online form
- You can report directly to Texas Children’s Health Plan at:
- Email: TCHPSIU@texaschildrens.org
- Fax: 832-825-8722
- Mail: Texas Children’s Health Plan, Controls and Compliance Department
- P. O. Box 301011 Houston, TX 77230-1011
- 1-832-828-1320