PARKLAND HEALTHfirst - Parkland Community Health Plan, Inc.

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To report providers use this address:
To report clients use this address:
Office of Inspector General
Office of Inspector General
Medicaid Provider Integrity/Mail Code 1361 General Investigations/ Mail Code1362
PO Box 85200 PO Box 85200
Austin, TX 78708-5200 Austin, TX 78708-5200
To report waste, abuse or fraud, 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
• When reporting about someone who receives benefits 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 waste, abuse, or fraud.
HHSC Regulatory Requirements for Fraud and Abuse
PCHP network providers agree to offer the following entities or their designees with prompt, reasonable and
adequate access to the network provider agreement and any records, books, documents, and papers that are
related to the network provider agreement and/or the network provider’s performance of its responsibilities
under this contract:
1. HHSC and MCO Program personnel from HHSC;
2. U.S. Department of Health and Human Services;
3. Office of Inspector General and/or the Texas Medicaid Fraud Control Unit;
4. An independent verification and validation contractor or quality assurance contractor acting on behalf of
HHSC;
5. State or federal law enforcement agency;
6. Special or general investigation committee of the Texas Legislature; and
7. Any other state or federal entity identified by HHSC, or any other entity engaged by HHSC.