- Go to https://oig.hhsc.texas.gov. (link is external) Click on “Report Fraud.” Fill out the online form.
- Call 800‑436‑6184.
- Call 2-1-1, then pick option 3.
- Mail a letter to:
- Mail: Medicaid Fraud Control Unit at the Office of the Attorney General, P.O. Box 12307, Austin, TX 78711-2307.
- Email: [email protected].
- Phone: (512) 463-2011.
- Fax: (512) 320-0974.
How to spot and report Medicare fraud?
There are many ways of Medicare fraud, but here are the most common ones:
- A health care provider bills Medicare for a service or item that you never received, or that is different from what you actually received
- Somebody uses a beneficiary’s Medicare card to receive medical services, items or supplies
- Medicare covered rental equipment was already returned, but Medicare is still billed for it
How do I report fraud, waste or abuse of Medicare?
You can report suspected fraud or corruption by:
- completing our reporting suspect fraud form
- completing our health provider fraud tip-off form
- calling our fraud hotline – 1800 829 403
- writing to us
How to report suspected Medicaid fraud?
Fraud and Abuse
- Call ChildLine at 1-800-932-0313. Issues with reporting electronically? ...
- Abuse of an Adult with a Disability. Suspect abuse of an adult with a disability? ...
- Medicaid Fraud. Unfortunately, a small number of Medical Assistance recipients and providers engage in practices that are fraudulent or abuse of the Medical Assistance program.
How do I identify Medicare fraud?
- Call Medicare’s help line at 800-633-4227.
- Call the Office of Inspector General directly at 800‑HHS‑TIPS (800‑447‑8477, or TTY 800‑377‑4950).
- File an online report with the Office of Inspector General.
What are red flags for Medicare fraud?
Some red flags to watch out for include providers that: Offer services “for free” in exchange for your Medicare card number or offer “free” consultations for Medicare patients. Pressure you into buying higher-priced services. Charge Medicare for services or equipment you have not received or aren't entitled to.
How do you address Medicare fraud?
If you suspect Medicare fraud, do any of these: Call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048. Call the fraud hotline of the Department of Health and Human Services Office of the Inspector General at 1-800-HHS-TIPS (1-800-447-8477). TTY users can call 1-800-377-4950.
What are the consequences of Medicare fraud?
It is illegal to submit claims for payment to Medicare or Medicaid that you know or should know are false or fraudulent. Filing false claims may result in fines of up to three times the programs' loss plus $11,000 per claim filed.
What is considered Medicare abuse?
What Is Medicare Abuse? Abuse describes practices that may directly or indirectly result in unnecessary costs to the Medicare Program. Abuse includes any practice that does not provide patients with medically necessary services or meet professionally recognized standards of care.
How do I report Medicaid fraud in Texas?
To file a Medicaid complaint, contact the Austin headquarters.Mail: Medicaid Fraud Control Unit at the Office of the Attorney General, P.O. Box 12307, Austin, TX 78711-2307.Email: [email protected]: (512) 463-2011.Fax: (512) 320-0974.
Who is in charge of Medicare fraud?
Medicare Fraud Strike Force | Office of Inspector General | Government Oversight | U.S. Department of Health and Human Services. A . gov website belongs to an official government organization in the United States.
What is the Red Flags Rule healthcare?
The Red Flags Rule requires that organizations have “reasonable policies and procedures in place” to identify, detect and respond to identity theft “red flags.” The definition of “reasonable” will depend on your practice's specific circumstances or specific experience with medical identity theft as well as the degree ...
What forms of fraud and abuse may be present in a health care setting?
Terms in this set (8) What forms of fraud and abuse may be present in a health-care setting? Forms may include the areas of false claims and billing practices, and the use of kickback schemes.
Which is the most common form of health care fraud and abuse?
Fraudulent provider billing, duplicate billing, and billing for services not medically needed accounted for 46 percent of provider fraud cases in 2016. Billing for services not performed is the most common provider fraud activity and defrauds millions from public and commercial insurers alike.
What are the three examples Medicare uses to describe abuse?
Common types of abuse include: Billing for unnecessary services (services that are not medically necessary) Overcharging for services or supplies. Misusing billing codes to increase reimbursement.
What is fraud?
Fraud is the crime of dishonestly taking something of value from someone else.
Who can report fraud?
Anyone can report fraud, waste or abuse. Texas Health and Human Services is required by law to refer suspected provider fraud to the Office of Inspector General.
How can I report suspected Medicare or Medicaid fraud?
Call 800-581-1790 to report healthcare fraud. You also can report it online through the Medicare and Medicaid Fraud Reporting Center (link is external) .
How to report abuse in Texas?
To report fraud, waste, or abuse in a Texas health and human services program, click here, or call the OIG fraud hotline, 1-800-436-6184. To report fraud, waste, or abuse regarding the expenditure of other state funds, contact the State Auditor's Office.
How to report food stamp fraud in Texas?
Let Us Know. You can report suspected fraud, waste, or abuse by recipients or providers in Texas health and human services programs online or by calling our toll-free fraud hotline (800-436-6184). The programs involved include: The Supplemental Nutrition Assistance Program (SNAP, formerly known as Food Stamps) ...
What to do if you suspect a provider of wrongdoing?
If you suspect a provider of wrongdoing, give the name and address of the clinic, office or business they work for. Any other information you think might be helpful to an investigator.
Do you get a tracking number when you submit a referral?
When you submit your referral, you will receive a tracking number. Keep this number handy; you will need to provide it if you have more information to add later. The OIG is prohibited from providing you with an update on the status of any open investigation. To report fraud, waste, or abuse in a Texas health and human services program, click here, ...
What is home health fraud?
Home health care fraud is when home health agencies bill insurers, government benefit programs, or homebound patients for unnecessary services or for services that were never delivered. This can also fall under Medicare or Medicaid fraud if the homebound patient receives home care as part of either benefit program.
What are the different types of drug fraud?
Drug Fraud and Abuse. There are a few common types of drug fraud and abuse: drug pricing fraud, counterfeit drug fraud, and drug diversion abuse. Drug pricing fraud is when a physician dishonestly prescribes unnecessary medication to a patient in order to profit from the sale. Counterfeit drug fraud is when a physician knowingly pushes stolen, ...
What is medical billing fraud?
Health insurance and medical billing fraud occurs when a health care provider or individual deceives an insurer in order to receive greater reimbursement. Examples of health insurance and medical billing fraud are: “Upcoding,” or billing for a more expensive service than the one actually performed. “Unbundling,” or billing each stage ...
What is billing for services not performed?
Billing for services not actually performed. “Upcoding,” or billing for a more expensive service than the one actually performed. “Unbundling,” or billing each stage of a procedure as if it were a separate procedure. Falsifying a patient's diagnosis to justify procedures that aren't medically necessary.
What is counterfeit drug fraud?
Counterfeit drug fraud is when a physician knowingly pushes stolen, expired or altered or fake prescription drugs. Drug diversion abuse is when a health care worker does not administer a patient’s medication but keeps it for personal profit.
What is the purpose of the Consumer Protection Division of the Office of the Attorney General?
The Consumer Protection Division of the Office of the Attorney General aims to help educate consumers on how to recognize fraud and abuse and how to file a complaint with the appropriate agency.
What is health care fraud?
Health care fraud is a deliberate deception or misrepresentation of services that results in an unauthorized reimbursement. Health care abuse refers to practices that are inconsistent with accepted medical, business, or fiscal practices. These practices can take many forms, the most common including: The Consumer Protection Division of the Office ...
How do you know if you are being abused by Medicaid?
It is a sad fact that too many Medicaid patients, especially the elderly, are physically abused or neglected by some health care providers. In many cases, an abused person is completely dependent on the abuser and is afraid to complain. There are warning signs of physical abuse, sexual abuse and criminal neglect: Cuts, black eyes, bruises and burns, especially when the caregiver cannot adequately explain how they happened (burns or bruises in an unusual pattern may indicate the use of cigarettes, instruments or similar items);
What is drug theft?
Drug theft is another form abuse since it deprives the patient of proper medication. Drug theft includes: A health care worker stealing a patient’s medication, selling it or keeping it for him/herself. A doctor selling prescription’s. A nurse order medication for patients without doctor’s approval.
What are some examples of Medicaid fraud?
A few examples of Medicaid fraud: A doctor billing Medicaid for X-rays, blood tests and other procedures that were never performed, or falsifying a patient’s diagnosis to justify unnecessary tests.
What is a pharmacy billing for Medicaid?
A pharmacist giving a Medicaid customer a generic drug and billing instead for the name brand version of the medication. A home health agency billing Medicaid for care not given, for care given to patients who have died or who are no longer eligible, or for care given to patients who have transferred to another provider.
What is Medicaid fraud control?
What is the Medicaid Fraud Control Unit? The Texas Medicaid Fraud Control Unit was created in 1979 as a division of the Office of the Attorney General. The unit has three principal responsibilities:
Can an ambulance transport Medicaid patients?
An ambulance company transporting Medicaid patients by ambulance when the patients can walk on their own and an ambulance is not medically necessary. A nursing home bookkeeper writing and cashing checks for herself from residents’ trust fund accounts set up to take care of the residents’ expenses.
What You Need to Know
HHS-OIG’s Hotline reviews and investigates thousands of complaints each year. We recommend you review Before You Submit a Complaint to understand the type of complaints we do and do not investigate and the complaint process.
How to Contact the OIG Hotline
Start your online complaint with HHS-OIG by selecting an option below. We accept complaints about fraud, waste and abuse in Medicare, Medicaid and other HHS programs and from HHS employees, grantees and contractors who are reporting wrongdoing at HHS and its programs (whistleblowers) for the first time.
Línea Directa de Comunicación del OIG – Sección de Operaciones
Contactar la línea directa de comunicación del OIG es tan fácil. La línea directa de comunicación del OIG acepta la información y quejas de todas las fuentes sobre la posibilidad de fraude, despilfarro, abuso ó mala administración dentro de los programas del Departamento Estadounidense de Salud & Servicios Humanos (U.S.