TYPES OF WASTE, ABUSE AND FRAUD
Medicaid Provider Integrity (Provider Investigations)
Return to Types of Waste, Abuse & Fraud
Medicaid Provider Integrity investigates activities relating to the prevention,
detection, and investigation of provider waste, abuse, and fraud in the Medicaid
and Children's Health Insurance Plan (CHIP) programs.
Medicaid and/or CHIP providers (e.g., doctor, dentist, counselor, etc.) should be
referred to Medicaid Provider Integrity for suspicion of waste, abuse and fraud
such as:
- Billing for services not rendered
- Billing for services not medically necessary
- “Up-coding” or inappropriate billing that results in a loss to the Medicaid program
- Inappropriate or lack of documentation to support services billed
- Quality of care issues that fail to meet professionally recognized health care standards
- Altering and/or falsifying documentation
- Soliciting kickbacks; and/or,
- Violating Medicaid and/or CHIP program policies, procedures, rules, regulations,
and/or statutes.
Need to reach the Medicaid Provider Integrity section directly? Please call the
toll-free hotline at 800-436-6184 or from the Austin metro area,
512-491-4056. You may also reach the section by fax, 512-973-3183.