If you suspect a client (a person who receives benefits) or a provider (e.g., doctor, dentist, counselor, etc.) has committed waste, abuse or fraud you have a responsibility and a right to, report it.
Reporting Provider/Clients Waste, Abuse and Fraud
You can report a provider / clients directly to your health plan at:
Seton Health Plan
Member Services
P.O. Box 14545
Austin, TX 78761
Seton Health Plan Toll Free Phone Number: 1-512-324-3124
Or if you have access to the Internet go to HHSC OIG website at http://www.hhs.state.tx.us and select "Reporting Waste, Abuse and Fraud". The site provides information on the types of waste, abuse and fraud to report. If you do not have Internet access and prefer to talk to a person, call the Office of Inspector General (OIG) Fraud Hotline at 1-800-436-6184, 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 a provider (e.g., doctor, dentist, counselor, etc.) provide the following:
- 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 is helpful
- Type of provider (physician, physical therapist, and pharmacist, etc.)
- Names and number of other witnesses who can aide in the investigation
- Dates of events
- Summary of what happened
When reporting a client (a person who receives benefits) provide the following:
- The person's name
- The person's date of birth, social security number, or case number if available
- The city where the person resides
- 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 1-800-368-1019. You can also view this information online at www.hhs.gov/ocr.