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Fraud, Waste and Abuse

Do you want to report waste, abuse or fraud?

Let us know if you think a doctor, dentist, pharmacist at a drug store, other health care providers, or a person getting benefits is doing something wrong. Doing something wrong could be waste, abuse, or fraud, which is against the law. For example, tell us if you think someone is:

  • Getting paid for services that weren't given or necessary.
  • Not telling the truth about a medical condition to get medical treatment.
  • Letting someone else use their Medicaid ID.
  • Using someone else's Medicaid ID.
  • Not telling the truth about the amount of money or resources he or she has to get benefits.

To report waste, abuse, or fraud, choose one of the following:

  • Call the OIG Hotline at 1-800-436-6184;
  • Visit https://oig.hhsc.state.tx.us/.  Under the box labeled "I WANT TO" click "Report Waste, Abuse, and Fraud" to complete the online form; or
  • You can report directly to your health plan:
    • Cook Children's Health Plan
      Attn: Fraud, Waste, and Abuse
      P. O. Box 2488
      Fort Worth, TX 76113-2488
      1-844-843-0004

To report waste, abuse or fraud, gather as much information as possible.

When reporting about a provider (a doctor, dentist, counselor, etc.) include:

  • Name, address, and phone number of provider
  • Name and address of the facility (hospital, nursing home, 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 about someone who gets 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