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Fraud, waste and abuse

You have the right to report anyone you believe has committed fraud, waste or abuse against the Texas Medicaid system.

Who do I send my report to?

If you suspect fraud, waste or abuse related to your Aetna Better Health® of Texas coverage, you can:

File online

Fill out an online fraud, waste and abuse form.

Call us

Report suspected cases to the Aetna Better Health of Texas Fraud and Abuse Hotline:

1-866-519-0916 (TTY: 711)

Call the state

Report suspected cases to the Office of Inspector General Hotline (Texas Health and Human Services):

1-800-436-6184

Mail a report

You can mail your report to:

Aetna Better Health of Texas
Attention: SIU Coordinator
PO Box 569150
Dallas, TX 75356-9150

Provider fraud, waste and abuse

Provider fraud, waste and abuse

Provider fraud, waste and abuse includes:

 

  • Using false info on medical records
  • Prescribing more medication than a person needs
  • Giving more health care services than a person needs
  • Billing for items or services without providing them
  • Billing for professional services when a medical professional didn’t perform the service

 

When reporting about a provider, you should include:

 

  • Provider name, address and phone number
  • Name and address of hospital, nursing home, home health agency, etc.
  • Provider or office Medicaid number, if you have it
  • Type of provider (doctor, dentist, therapist, pharmacist or other)

Member fraud, waste and abuse

Member fraud, waste and abuse includes:

 

  • Lending, selling or giving a health plan ID card or Texas benefits Medicaid card to someone else
  • Getting the same treatments or medications from more than one provider 
  • Using someone else’s Social Security number or health plan ID number
  • Receiving money or gifts in return for using medical services 

 

When reporting about members, you should include the:

 

  • Person’s name
  • Person’s date of birth, Social Security number or case number, if you have it
  • Person’s phone number and address
  • City where the person lives
  • Type of complaint

Tips on reporting

Tips on reporting

Describe the action that may be fraud or abuse. Some examples are when: 

 

  • A provider bills you for services that you didn’t receive or that weren’t provided
  • Someone else uses your identity to get medical services

 

You’ll want to know the answers to these questions:

 

  • What are the names and phone numbers of people who can help with the investigation?
  • When did the event happen (dates)?
  • What happened (a summary)?
  • Did someone call the police?
 
Your info stays private
 
Your identity and contact info will be kept private to the extent the law allows.