How to Report Health Care Fraud

You have the right to respect and dignity, including freedom from abuse, neglect, and exploitation.

What are Abuse, Neglect, and Exploitation?

Abuse is mental, emotional, physical, or sexual injury, or failure to prevent such injury.

Neglect results in starvation, dehydration, over medicating or under medicating, unsanitary living conditions, etc. Neglect also includes lack of heat, running water, electricity, medical care, and personal hygiene.

Exploitation is misusing the resources of another person for personal or monetary gain. This includes taking Social Security or SSI (Supplemental Security Income) checks, abusing a joint checking account, and taking property and other resources.

Reporting Abuse, Neglect, and Exploitation

The law requires that you report suspected abuse, neglect or exploitation, including unapproved use of restraints or isolation that is committed by a provider.

Call 911 for life-threatening or emergency situations.
Report by Phone (non-emergency); 24 hours a day, seven days a week, toll-free.

Report to the Department of Aging and Disability Services (DADS) by calling 1-800-647-7418 if the person being abused, neglected, or exploited lives in or receives services from a:

  • Nursing facility;
  • Assisted living facility;
  • Adult day care center;
  • Licensed adult foster care provider; or.
  • Home and Community Support Services Agency (HCSSA) or Home Health Agency

Suspected abuse, neglect or exploitation by a HCSSA must also be reported to the Department of Family and Protective Services (DFPS).

Report all other suspected abuse, neglect, or exploitation to DFPS by calling 1-800-252-5400.

Report Electronically (nonemergency) at the DFPS website

This is a secure website. You will need to create a password-protected account and profile.

Do You Want to Report Waste, Abuse or Fraud?

Let us know if you think a doctor, dentist, pharmacist at a drug store, other health care provider or a person getting Medicaid 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 ID
• Using someone else’s Medicaid ID
• Not telling the truth about the amount of money or resources he or she has to get benefits.

To report waste, abuse or fraud, choose one of the following:

  • Call the Office of Inspector General (OIG) Hotline at 1-800-436-6184
  • Report Waste, Abuse and Fraud online
  • You can report directly to your health plan:
    Blue Cross and Blue Shield of Texas
    P.O. Box 660044
    Dallas, Texas 75266-9506

To report waste, abuse or fraud, gather as much information as possible. You can report waste, abuse or fraud to BCBSTX's Special Investigations Hotline 24 hours a day, seven days a week toll-free at 1-800-543-0867. The hotline is confidential and anonymous.

When reporting about a provider (a doctor, dentist, counselor, etc.) include:

  • Name, address, and phone number of the provider
  • Name and address of the facility (hospital, nursing home, home health agency, etc.)
  • Medicaid number 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

Inspector General Integrity Initiative

We are part of the Inspector General Integrity Initiative and have pledged to partner with the Office of Inspector General (OIG) to fight fraud, waste and abuse in Texas' Medicaid program. To learn more, visit the OIG website or view this Fraud, Waste and Abuse brochure.

If you have any questions, you can contact the Customer Advocate Department at 1-877-688-1811 (TTY 711).

Learn How Your Plan Works

To learn more about Reporting Health Care Fraud, see the Member Handbook

Find a Doctor or Hospital

Use our Provider Finder® to search for doctors and other health care providers near you.

Contact Us