How to Report Fraud & Abuse on Medicare Home Health in Texas

It's important to report any fraud or abuse of the Medicare system so the perpetrators can be stopped. Although the Attorney General of Texas has established the Civil Medicaid Fraud office, there is no equivalent organization in Texas to prosecute Medicare fraud. Residents of Texas can report Medicare fraud to their Medicare claims processing company or the United States Attorney General.

Instructions

• 1

  Contact the home health service and ask them to explain any items on the Medicare Summary Notice that you think are fraudulent. It's possible that they have made a mistake you don't need to report. If the home health service is unhelpful or you are unsatisfied with their response to your concern, you should report the possible fraud.

• 2

  Write down the information relating to the fraudulent claim, which is all displayed on the Medicare summary notice. This includes the home care agency's name and identifying number, the possibly fraudulent service, the date of service, the amount paid, the date of the Medicare Summary Notice and the name and Medicare number of the patient. Also note the reasons you think that Medicare shouldn't have paid the claim.

• 3

  Find the address and phone number of the Medicare company who paid the fraudulent claim on the Medicare summary nNotice. Call the company at the phone number listed and provide them with all the information they request. If you prefer, you can send a letter to the address listed on the Medicare Summary Notice to the attention of the Fraud Unit.