Call the OIG Fraud Hotline if you suspect wrongdoing

Tips from the public to the OIG Fraud Hotline play a vital role in safeguarding taxpayer dollars and protecting the Texans who receive $42 billion in Medicaid and other benefits each year. The OIG established the hotline in 2011 to protect those resources.

The hotline’s goal is to identify solid allegations of fraud, waste and abuse and pass those reports to OIG investigators. The OIG works with the public and health care professionals to accomplish that goal.

How it works

Providers, staff, patients and the public may call to report observations of other providers, managed care organizations or program beneficiaries. An initial call to the hotline generally takes about five minutes; it includes basic questions about the allegation and determines if a complaint needs further investigation.

If a complaint is Medicaid-related and contains sufficient provider-identifying information, a case is opened and assigned to an intake investigator. The investigator determines whether a complaint represents a violation of Medicaid policy or federal and state law or regulation.

Possible outcomes

Based on the findings of a preliminary investigation, a case may be closed; concluded with a recommendation for provider education; referred to another agency or entity; or referred for a full-scale investigation.

The hotline manager and six specialists receive approximately 200 calls per day, adding up to 5,491 calls answered in the third quarter of fiscal year 2020. Fraud hotline staff sent 1,262 of those calls for further investigation or action to the appropriate OIG division. Another 829 callers were referred to another area in Texas Health and Human Services, another state agency or to another entity that could better address their concerns.

How to report

The OIG Fraud Hotline is answered from 8 a.m. to 5 p.m. Monday through Friday. Call 800-436-6184 to make a report. Callers are asked to provide contact information, which is used if an investigator has further questions. A caller may choose to remain anonymous, but there are incidents where a first-hand account is helpful. To remain truly anonymous, make the report online through ReportTexasFraud.com.