Health care fraud is going up every year. Molina and the State of Texas are working together to help prevent waste, abuse and fraud.
These terms mean:
Fraud - Knowingly submitting false claims in order to receive payment.
Abuse - Taking advantage of loopholes in the law to increase payment.
Waste - Making excessive payments due to poor training and education.
Waste, abuse, and fraud hurt everyone. It raises taxes. It reduces funds available to pay benefits. It may even reduce the quality of care.
Let us know if you think a doctor, dentist, pharmacist at a drug store, or other health care providers is doing something wrong. Let us know if a person getting benefits is doing something wrong. Doing something wrong could be waste, abuse, or fraud. This is against the law. 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, pick one of the following: Call the OIG Hotline at (800) 436-6184 or
- Visit https://oig.hhsc.state.tx.us/ and pick "Click Here to Report Waste, Abuse, and Fraud" to complete the online form; or
- You can report directly to your health plan:
Molina Healthcare of Texas
Attention: Compliance Officer
5605 N. MacArthur Blvd., Suite 400
Irving, Texas 75038
Compliance AlertLine: (866) 606-3889
Compliance Fax: (866) 887-1749 Email: firstname.lastname@example.org
To report waste, abuse or fraud, get 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