Fraud and Abuse - Texas Vaccines for Children

Chapter 6 - Fraud and Abuse

Download Chapter 6 - Fraud and Abuse to find the ways to report, the definitions, and the repercussions for fraud and abuse in the Texas Vaccines for Children Program.

Reporting Fraud and Abuse

Suspected fraud or abuse can be reported to the TVFC Program or the responsible entity (DSHS HSR or LHD) via email, telephone, fax, or letter. Furthermore, newspaper articles and internet pages that promote potential fraudulent situations are investigated. The responsible entity (DSHS HSR or LHD) and DSHS quality assurance (QA) contractors must report all cases of alleged or suspected fraud or abuse. Reports received by the DSHS Immunization Unit in any form that merit further investigation will be referred to the Centers for Medicare and Medicaid Services (CMS), Medicaid Integrity Group (MIG) Field Office. The state Medicaid agency will conduct preliminary investigations and, as warranted, refer appropriate cases to the state’s Medicaid Fraud Control Unit following the Federal Regulatory scheme at 42 CFR section 455.15 and 42 CFR section 455.23.