Do you know how to report fraud, waste, and abuse?

Date: 03/26/19

Superior makes it easy for you to report fraud, waste, and abuse. If you think a doctor, dentist, pharmacist at a drug store, other health-care providers, or a person getting benefits is doing something wrong let us know. 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 were not 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 they have, in order to get benefits.

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

• Call the Office of Inspector General (OIG) Hotline at 1-800-436-6184.
• Visit the Office of Inspector General website and click the red “Report Fraud” box to complete the online form.
• Report directly to Superior HealthPlan by:
  Mail:       Superior HealthPlan
                 Attn: Compliance Department
                 5900 E. Ben White Blvd.
                 Austin, TX 78741
  Phone:   1-866-685-8664

To report fraud, waste, or abuse, gather as much information as possible. When reporting about a provider (a doctor, dentist, counselor, etc.), include:

• Name, address, and phone number of 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 and social security number (and case number, if you have it).
• The city where the person lives.
• Specific details about the fraud, waste, or abuse.