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STAR (Medicaid) Fraud, Waste and Abuse

How do I report someone who is misusing/abusing the programs or services?

If you suspect a person who receives benefits or a provider (a doctor, dentist, counselor, etc.) has committed waste, abuse or fraud you have a responsibility and a right to report it.

You can report directly to your health plan any providers or persons who receive benefits you suspect of waste, abuse or fraud:

Cook Children's Health Plan
Attention: Compliance
P.O. Box 2488
Fort Worth, TX 76113-2488
1-800-964-2247

Or go to www.hhsc.state.tx.us and select the "Reporting Waste, Abuse and Fraud" tab on the left side of the screen. The site tells you about the types of waste, abuse and fraud to report. If you would rather talk to a person, call the HHSC Office of Inspector General Fraud Hotline at 1-800-436-6184. You also can send a note or letter to the following addresses:

To report Providers, use this address:

Office of Inspector General
Medicaid Provider Integrity/Mail Code 1361
P.O. Box 85200
Austin, TX 78708-5200

To report someone who receives benefits, use this address:
Office of Inspector General
General Investigations/Mail Code 1362
P.O. Box 85200
Austin, TX 78708-5200

To report waste, abuse or fraud, gather as much information as possible. When reporting a provider (a doctor, dentist, counselor, etc.) include:

  • Name, address, and phone number of provider.
  • Name and address of the facility (hospital, nursing home and home health agency, etc.).
  • Medicaid number of the provider and facility, if you have it.
  • Type of provider (doctor, dentist, therapist, pharmacist, etc.).
  • Names and phone numbers of other witnesses who can help in the investigation.
  • Dates of events.
  • Summary of what happened.

When reporting someone who receives benefits, include:

  • The person's name.
  • The person's date of birth, Social Security Number, or case number, if you have it.
  • The city where the person lives.
  • Specific details about the waste, abuse or fraud.

 

Please call our Member Services Department at 1-800-964-2247 for any questions or to tell us about any concerns or problems you have with our Plan. Member Services is available from 8 a.m. to 5 p.m. Monday through Friday.