PROVIDER MANUAL - Sendero Health Plans

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Sendero Provider Manual Page 72 of 184 10.0 – Fraud, Waste or Abuse REPORTING FRAUD, WASTE OR ABUSE BY A PROVIDER OR CLIENT MEDICAID MANAGED CARE AND CHIP Do you want to report Fraud, Waste or Abuse? Let us know if you think a doctor, dentist, pharmacist at a drug store, other health care provider, or a person getting benefits is doing something wrong. Doing something wrong could be fraud, waste or abuse, 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 or CHIP ID. Using someone else’s Medicaid or CHIP ID. Not telling the truth about the amount of money or resources he or she has to get benefits. To Report Fraud, Waste or Abuse, chose one of the following: Call the OIG Hotline at 1-800-436-6184 Visit https://oig.hhsc.state.tx.us/ and pick “Click Here to Report Fraud, Waste or Abuse” to complete the online form; or You can report directly to your health plan o Sendero Health Plans 2028 East Ben White, Suite 510 Austin, TX 78741 1-855-297-9191 To report fraud, waste or abuse, gather as much information as possible. When reporting a provider (a doctor, dentist, counselor, etc.) include: o Name, address, and phone number of provider o Name and address of the facility (hospital, nursing home, home health agency, etc.) o Medicaid number of the provider and facility, if you have it o Type of provider (doctor, dentist, therapist, pharmacist, etc.) o Names and phone numbers of other witnesses who can help in the investigation o Dates of events o Summary of what happened. Sendero Customer Services 1-855-526-7388 Network Management 1-855-895-0475 Health Services Dept.: 1-855-297-9191 (FAX 1-512-275-2862)
Sendero Provider Manual Page 73 of 184 When reporting someone who receives benefits such as a Member, include: o The person’s name o The person’s date of birth, Social Security number, or case number if you have it o The city where the person lives o Specific details about the fraud, waste or abuse. Sendero Customer Services 1-855-526-7388 Network Management 1-855-895-0475 Health Services Dept.: 1-855-297-9191 (FAX 1-512-275-2862)
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PROVIDER MANUAL - Sendero Health Plans

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