Reporting Fraud, Waste and Abuse
Superior HealthPlan is serious about finding and reporting times that Texas Medicaid funds are used in the wrong way. This is called waste, fraud or abuse.
Waste is the overuse of services that may result in costs not needed for health care benefits. This includes direct costs and indirect costs. Waste usually results from the misuse of services.
Do you want to report fraud, waste or abuse?
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 fraud, waste or abuse, 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 fraud, waste or abuse, choose one of the following:
Call the Office of Inspector General (OIG) Hotline at 1-800-436-6184 or fill out the OIG form online. Report directly to Superior at:
Attn: Compliance Department
5900 E. Ben White Blvd.
Austin, TX 78741
To report fraud, waste or abuse, 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 the number 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 fraud, waste or abuse.