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The Texas 5913 form is a critical document used for reporting suspected provider fraud within the Texas Department of Aging and Disability Services. This form serves as a formal referral mechanism for individuals or entities who have observed potential fraudulent activities related to various service providers. Understanding its purpose and the information required can significantly impact the integrity of services offered to vulnerable populations in Texas.

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The Texas 5913 form serves a critical function in the oversight of service providers within the state’s aging and disability services framework. This form is specifically designed to facilitate the reporting of suspected provider fraud, ensuring that consumers' rights are upheld and that any fraudulent activities are addressed promptly. The document includes sections for identifying the provider, detailing the suspected fraudulent activity, and providing contact information for witnesses and law enforcement agencies involved. It captures essential data such as the provider's legal entity name, contract number, and the type of services offered, ranging from adult foster care to hospice care. Additionally, the form requires information about the nature of the suspected fraud, whether it involves billing irregularities or falsification of records. By outlining the specifics of the suspected fraudulent activity, the form aids in determining the appropriate course of action, whether it be an administrative review or a more in-depth investigation. This structured approach not only helps in maintaining accountability but also protects the interests of those reliant on these essential services.

Dos and Don'ts

When completing the Texas 5913 form, it is essential to adhere to specific guidelines to ensure accuracy and compliance. Below is a list of ten things to do and not to do while filling out the form.

  • Do provide complete and accurate contact information for all parties involved.
  • Do specify the type of suspected fraudulent activity clearly.
  • Do use the correct legal entity name when identifying the provider.
  • Do indicate whether law enforcement has been notified.
  • Do document the date or date range of the suspected fraudulent activity.
  • Don't leave any sections blank; fill out all required fields.
  • Don't provide vague descriptions of the suspected fraud; be specific and detailed.
  • Don't use abbreviations or jargon that may confuse the reviewer.
  • Don't submit the form without reviewing it for errors or omissions.
  • Don't forget to keep a copy of the completed form for your records.

Get Answers on Texas 5913

What is the Texas 5913 form used for?

The Texas 5913 form is a referral document utilized by the Texas Department of Aging and Disability Services (DADS) to report suspected provider fraud. It is specifically designed for use by the Consumer Rights and Services (CRS) division. This form captures essential information regarding the alleged fraudulent activity, including details about the provider, the nature of the suspected fraud, and any witnesses involved.

Who can submit a Texas 5913 form?

The form can be submitted by any staff member of DADS who has knowledge of suspected fraudulent activities related to service providers. This includes individuals in various positions within DADS, such as those working in regulatory services, oversight, or compliance. Additionally, other stakeholders who have relevant information may also assist in providing details for the referral.

What types of suspected fraudulent activities can be reported using this form?

The Texas 5913 form allows for the reporting of several types of suspected fraudulent activities, including but not limited to:

  1. Billing irregularities
  2. Falsification or alteration of records
  3. Trust fund irregularities
  4. Other specified types of fraud

Each type of activity must be clearly defined in the referral to ensure proper investigation.

What information is required when filling out the Texas 5913 form?

When completing the Texas 5913 form, several key pieces of information must be provided, including:

  • Contact information for the DADS staff submitting the referral
  • Details about the provider, including their legal entity name and physical address
  • Information regarding the suspected fraudulent activity, including dates and types
  • Witness information, if applicable
  • Any relevant notifications to law enforcement or other entities

This comprehensive data collection is crucial for facilitating an effective investigation.

What happens after a Texas 5913 form is submitted?

Once the Texas 5913 form is submitted, it is reviewed by the appropriate staff within DADS. If the referral is deemed valid, it may lead to further investigation by the Office of Inspector General (OIG) or other regulatory bodies. The form also initiates the tracking of the referral through a log, allowing for monitoring of the case's progress.

Can the provider's payments be suspended as a result of a referral?

Yes, the provider's payments may be suspended if the referral indicates significant concerns regarding fraudulent activities. This action is taken to prevent further potential losses while the investigation is ongoing. However, it is important to assess whether such a suspension would jeopardize access to care for individuals relying on the provider's services.

Is there a deadline for submitting the Texas 5913 form?

While there is no explicit deadline stated for submitting the Texas 5913 form, timely reporting is essential. Delays in submission may hinder the investigation process and allow for further fraudulent activities to occur. Therefore, individuals are encouraged to submit the form as soon as they suspect fraudulent behavior.

What should be done if a witness has information about the suspected fraud?

If a witness has relevant information regarding the suspected fraud, their contact details should be included in the Texas 5913 form. This includes their name, relationship to the provider, and a physical address. Witnesses may be contacted for further information during the investigation process, and their testimony can be crucial in substantiating the claims made in the referral.

How can one access the Texas 5913 form?

The Texas 5913 form can typically be accessed through the Texas Department of Aging and Disability Services' official website or by contacting the department directly. It is important to ensure that the most current version of the form is used to avoid any issues during the submission process.

How to Use Texas 5913

Completing the Texas 5913 form requires careful attention to detail. Each section of the form is designed to gather specific information regarding suspected fraudulent activity related to providers. Following the steps outlined below will ensure that the form is filled out correctly and efficiently.

  1. Obtain the Form: Download the Texas 5913 form from the appropriate Texas Department of Aging and Disability Services (DADS) website or obtain a physical copy from your office.
  2. Fill in the Date: Enter the date when the fraud referral is received by the Consumer Rights and Services (CRS) and the date it is sent to the HHSC Office of Inspector General (OIG).
  3. Contact Information for DADS Staff: Provide your name, title or position, DADS area, state office region number, and office contact information, including address, phone number, and email.
  4. Witness Information: If applicable, fill in the names, phone numbers, relationships to the provider, and physical addresses of individuals who have information about the suspected fraudulent activity.
  5. Law Enforcement Notification: Indicate whether a law enforcement agency has been notified. If yes, provide the name of the agency, date notified, and contact details of the individual contacted.
  6. Other Entity Notification: Specify if any other entities (like insurance companies or banks) have been notified. Include the entity's name, date notified, and contact details.
  7. Provider Information: Fill in the name of the legal entity, doing business as (d.b.a.), Texas ID number, contract number, license number, type, facility ID number, provider identifier number, physical address, and business mailing address.
  8. Type of Provider: Select the appropriate type of provider from the list provided.
  9. Type of Suspected Fraudulent Activity: Choose the type of suspected fraudulent activity from the options given. If “Other,” specify the nature of the fraud.
  10. Date of Activity: Indicate the date or date range during which the suspected fraudulent activity occurred.
  11. Type of Review: Mark the type of review that was conducted regarding the suspected fraud.
  12. Sample Size and Review Period: Enter the total sample size and the total number of individuals served during the review period.
  13. Corrective Action: Answer whether corrective action or recoupment was requested as a result of the review and specify any amounts due to DADS.
  14. Technical Assistance: Indicate if the provider received technical assistance on billing in the past two years and list the dates.
  15. Level B Citations: For specific licensed providers, enter the number of Level B citations issued for the license associated with the contract.
  16. Detailed Description: Provide a thorough description of the suspected fraudulent activity.
  17. Access to Care: Assess whether access to care would be jeopardized if the provider's payments are suspended and provide an explanation if necessary.
  18. Suspension of Payments: State whether there is any reason why the provider's payments should not be suspended, and if so, provide details.
  19. Submission: After completing the form, email it to Providerfraud@dads.state.tx.us as directed.

Common mistakes

Filling out the Texas 5913 form can be a straightforward task, but several common mistakes can lead to complications or delays in processing. One of the most frequent errors is failing to provide complete contact information for the DADS staff submitting the referral. Missing details such as the name, title, or telephone number can hinder communication and slow down the investigation process.

Another mistake is neglecting to specify the type of suspected fraudulent activity. The form offers various options, such as billing irregularities and falsification of records. Not selecting the appropriate category may result in confusion and could delay the referral's review. It is essential to be precise in this section to ensure the referral is directed to the right investigative team.

Many individuals also overlook the importance of detailing the physical address where the suspected fraudulent activity occurred. Providing a complete and accurate address is crucial for investigators to locate the site of the alleged fraud. If this information is incomplete, it could lead to unnecessary delays in the investigation.

Additionally, some people fail to document whether law enforcement has been notified about the suspected fraud. This information is vital as it informs the reviewing agency of any concurrent investigations. Omitting this detail can create gaps in the referral process, leading to potential misunderstandings about the status of the case.

Another common oversight involves not including a detailed description of the suspected fraudulent activity. A vague or incomplete description can leave investigators with more questions than answers. A clear and thorough account of the alleged fraud will facilitate a more efficient review and increase the likelihood of appropriate action being taken.

Finally, individuals sometimes forget to indicate if the provider has received technical assistance on billing in the past two years. This information can provide context for the referral and may influence the outcome of the investigation. By ensuring this detail is included, the person submitting the form can help the reviewing agency better understand the provider's history and any prior issues.

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