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 "Report Fraud” to complete the online form
• You can report directly to Texas Children’s Health Plan at:
  • Texas Children’s Health Plan’s new Fraud, Waste, and Abuse Hotline is a dedicated resource designed specifically for our Network Providers. We understand the critical importance of maintaining the highest standards of integrity and compliance within our healthcare network. The new hotline is 866-828-4924, or visit https://tchpintegrity.com/.
  • Email: TCHPSIU@texaschildrens.org
  • Fax: 832-825-8722
  • Mail: Texas Children’s Health Plan, Controls and Compliance Department
  • at P. O. Box 301011 Houston, TX 77230-1011
  • You can also reach the Controls and Compliance Department at 1-832-828-1320