STAR Kids Fraud & Abuse | Texas Children's Health Plan
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STAR Kids Fraud & Abuse

 

Help the HHSC plan for your future housing needs

 

The Texas Health and Human Services Commission (HHSC) is looking to create a Housing Choice Plan for individuals with mental health conditions, substance use histories and/or intellectual and developmental disabilities. The “Housing Choice Plan” is a program where the HHSC provides affordable housing assistance to individuals who meet certain requirements. They need input from members of Texas Children’s Health Plan to be successful.
 
 
*Responses to the survey are anonymous and confidential. Answers will not change an individual’s ability to receive or provide services.
Health-care billing mistakes happen a lot. The rules that doctors and hospitals must follow are very tricky. Mistakes also happen because the doctor’s office or emergency room is just really busy. Most doctors and hospitals want to do what is right. They want to follow the rules and take care of your family.
 
But, you may have read about hospitals and providers that have cheated the system. They billed for services they did not do, or worse. We need your help to stop this. Texas Children’s Health Plan has been authorized by the State of Texas to help identify and prevent fraud, abuse, and waste. These terms mean:
 
  • Fraud-Knowingly submitting false claims in order to receive payment.
  • Abuse-Taking advantage of loopholes in the law to increase payments.
  • Waste-Making excessive payments due to poor training and education.
Fraud, abuse, and waste hurts everyone. It raises taxes. It reduces funds available to pay benefits. It may even reduce the quality of care.
Some examples of fraud you might see include:
 
  • Providers billing for services your family did not receive.
  • Billing for different services than what you received.
  • Asking for your member ID number when you are not going to the clinic or hospital.
  • Offering money for your member ID number.
  • Offering prizes or payments for you to come to a clinic or hospital.
Be on the lookout for common scams such as:
 
  • Statements that “Your health plan wants you to have this service.”
  • Telemarketing or door-to-door salespeople offering medical services.
  • Saying that the more tests that are done, the cheaper they are for the government.
To help us prevent fraud, follow these tips:
 
  • Don’t give out your member ID number to anyone you do not know. Only give it to your doctor or hospital.
  • Don’t ask for services you don’t need.
  • Be careful of anyone saying “The services are free, so you should use my clinic.”
Can members commit fraud?
 
Some members do commit fraud. They might change doctors to feed a bad habit. They might ask for services they do not need or they may lie to a doctor. Some may even work with a doctor to commit fraud in return for money. Member fraud is against the law. Member fraud could result in losing your benefits. It can also mean fines or jail.
 
If you suspect fraud, abuse, or waste
 
What if you suspect fraud? Contact us immediately. Do not wait more than one day.
 
Texas Children’s Health Plan’s fraud hotline is 1-832-828-1320. The fax number is 1-832-825-8772. You can e-mail us at TCHPSIU@texaschildrens.org.
 
Or send a letter to:
 
Texas Children’s Health Plan
Fraud and Abuse Investigations
Mail Code WLS 8360
PO Box 301011
Houston, TX 77230-1011
 
You do not have to give your name. Just tell us why you think there is fraud. Give us the name of the provider and tell us what you are worried about. We will take your concerns seriously. We will investigate every case. We may even send your concern to the State. Most often, we will teach the provider what they did wrong.
 
Please help us
 
Texas Children’s Health Plan wants to identify and prevent fraud. We need, and appreciate, your help! Call us with any questions.