Chapter 6: Fraud Prevention

As a CDS employer, you are accountable for the public Medicaid funds spent through the CDS option. You must understand that if you submit false or fraudulent time sheets, you will be reported to the appropriate authorities for investigation and possible prosecution of Medicaid fraud.

What is Medicaid Recipient Fraud?

Intentional deception or misrepresentation made by a person with the knowledge that the deception could result in some unauthorized benefit to that person or some other person.

Examples of Medicaid fraud may include:

  • Falsifying time sheets

    • Submitting a time sheet with extra hours that were not worked

    • Employee signs for work not provided and employer approves time sheet with knowledge that employee did not provide services

    • Falsifying employee signature on timesheets

    • Approving a timesheet for a service provider who worked at another job or was out of state during that time period.

  • Employer and employee splitting payroll checks

  • Hiring a person not eligible to provide services because they do not meet program requirements or have not passed criminal history checks.

  • Requiring a service provider to provide tasks not approved on the service plan

  • Submitting a timesheet for a service provider while the individual is hospitalized.

Who Can Report Fraud?

Anyone can report fraud, waste or abuse, including FMSAs, case managers, service coordinators, service providers, or family members. The Texas Department of Aging and Disability Services (DADS) is required by law to refer suspected provider fraud to the Office of Inspector General.

How Can I Report Suspected Fraud?

Call the Texas Health and Human Services Commission Office of Inspector General at 1-800-436-6184 or visit https://oig.hhsc.state.tx.us/wafrep/ to file an online report.

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Updated: May 27, 2016