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