Waste, Abuse and Fraud

Let us know if you think a doctor, dentist, pharmacist at a drug store, other health care provider, or a person getting Medicaid 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 Medicaid services that weren’t given or necessary.
  • Offering gift cards or anything else of value to get Medicaid patients.
  • Getting Medicaid services that are not approved.
  • Not telling the truth about a medical condition to get medical treatment.
  • Letting someone else use a Medicaid ID.
  • Using someone else’s Medicaid ID.
  • Not telling the truth about the amount of money or resources they have.

To report waste, abuse, or fraud, you can do one of the following:

  • Call 1-800-436-6184.
  • Visit the website of the Office of Inspector General. Click on “Report fraud, waste, or abuse” under the heading “I Want To:” Fill out the online form.
  • Mail a letter to report a doctor, pharmacist, or other provider to:

Office of Inspector General
Medicaid Provider Integrity / Mail Code 1361
PO Box 85200 Austin, TX 78708-5200

  • Mail a letter to report a person who gets Medicaid to:

Office of Inspector General
General Investigations / Mail Code 1368
PO Box 13247 Austin, TX 78711

Why Report Waste, Abuse, and Fraud?

It cheats everyone.

Taxpayers pay for waste, abuse, and fraud of Medicaid services. These activities result in less money from patient care, and more spending to try and stop these illegal activities.

It hurts Medicaid clients.

People who need services might not get them and some people may get more than they should, which can be harmful.

It’s illegal.

The person who knowingly falsifies Medicaid records or claims can be charged with a crime. So can the person who tells them to falsify. So can anyone who knew or should have known what was happening.