8000, Sanctions, Fraud and Abuse

Revision 13-0; Effective September 3, 2013

Rule: 40 Texas Administrative Code, Chapter 49, Subchapter F.

The Department of Aging and Disability Services (DADS) identifies and refers cases of suspected fraud or abuse of Medicare, Medicaid or social services program funding or resources to the Texas Health and Human Services Commission, Office of Inspector General (HHSC-OIG).

If directed to do so by the OIG, DADS excludes from program reimbursement any provider agency that defrauds or abuses a Medicare or Medicaid program. DADS suspends, in the event that the U.S. Department of Health and Human Services (HHS) directs the suspension, any recipient of Medicaid reimbursement who has been convicted of a crime related to the delivery of medical care or services under Medicare, Medicaid or social services programs.

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8100, Report Fraud

Revision 13-0; Effective September 3, 2013

A provider agency must report suspected waste, fraud or abuse in health and human services programs to the Texas State Auditor's Office at 1-800-TX-AUDIT (1-800-892-8348), and to the HHSC Office of Inspector General at 1-800-436-6184.

Additional reporting resources are:

  • DADS Consumer Rights and Services (CRS) Complaint Intake Hotline: 1-800-458-9858;
  • DADS contract manager; or
  • DADS case manager.

All reports are kept confidential except as required by state or federal law. For further information, visit the site at How Do I Report Suspected Fraud or Misuse of State Resources?.