Reporting Fraud, Waste, or Abuse

Dell Children's > Dell Children's Health Plan > For Members > Plan Directories and Rules > Reporting Fraud, Waste, or 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 800-436-6184
  • Visit https://oig.hhsc.state.tx.us. Select the box labeled “Report Fraud” to complete the online form.
  • Report directly to your health plan:

Compliance Officer
Dell Children’s Health Plan Appeals
2505 N. Highway 360
Suite 300
Grande Prairie, TX 75050
800-315-5385

Dell Children’s Health Plan Toll Free Phone Number: 888-596-0268 (TTY 711)

You may also visit the Texas Office of Consumer Credit Commissioner or the Office of Inspector General. If you prefer to talk to a person, call the Office of Inspector General (OIG) Fraud Hotline at 800-436-6184, or you may send a written statement to the following OIG 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 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

If you think you have been treated unfairly or discriminated against, call the U.S. Department of Health and Human Services toll-free at 800-368-1019. You can also view this information online at www.hhs.gov/ocr.