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Reporting Fraud, Waste or Abuse by a Provider or a Client

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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 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 or CHIP ID
  • Using someone else’s Medicaid or CHIP ID
  • Not telling the truth about the amount of money or resources he or she has to get benefits
Report directly to Scott and White Health Plan using the following contact information:
  • RightCare from Scott and White Health Plan
    Attn: Compliance Officer
    1206 West Campus Drive
    Temple, TX 76502
    Phone Number: 1-888-484-6977
    TTY 1-866-220-2831
  • Fraud, waste, and abuse harms us all. If you think a doctor, other provider, or a person who gets benefits is misusing state benefits.
      • Call the HHSC Inspector General Integrity Line at 1-800-436-6184
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.)
  • TPI and/or NPI 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

RightCare proposes an aggressive, proactive fraud and abuse program that complies with state and federal regulations. Our program targets areas of health care related fraud and abuse including internal fraud, electronic data processing fraud and external fraud.

A Special Investigations Unit (SIU) will be a key element of the program. This SIU will detect, investigate and report any suspected or confirmed cases of fraud, abuse or waste to the Office of Inspector General (OIG). During the investigation process, the confidentiality of the patient and or people referring the potential fraud and abuse case is maintained.

RightCare will use a variety of mechanisms to detect potential fraud or abuse. All key functions including Claims, Provider Relations, Member Services, Medical Management, as well as providers and members, will share the responsibility to detect and report fraud. Review mechanisms will include audits, review of provider service patterns, hotline reporting, claim review, data validation and data analysis.