HHS-OIG Fraud Scheme Alert

Date: March 25, 2025

Attention: All Providers

Call to action: Texas Children’s Health Plan would like to share an alert from the U.S. Department of Health and Human Services, Office of the Inspector General (HHS-OIG). HHS-OIG in cooperation with other law enforcement partners, is notifying payers about high-risk requests to re-route electronic funds transfers (EFTs) to fraudulent accounts owned by cybercriminals. State Medicaid agencies have been targeted, and an HFPP Partner noted that fraudulent EFT forms were transmitted to Medicaid to redirect funds from an institutional provider. Private sector payers have also been targeted, but currently there are no losses reported.

Partners receiving high-risk requests should:

• Confirm the requestor’s identity using information on file, not what was provided in the request.
• Refrain from providing financial or sensitive information over the phone or through email.
• Contact your HFPP Partner Liaison to be connected to the law enforcement agency investigating this scheme.

Next step for providers: Providers should share this communication with their staff

If you have any questions, please email Provider Relations at: providerrelations@texaschildrens.org. 

For access to all provider alerts: https://www.texaschildrenshealthplan.org/providers/provider-news/provider-alerts.