Get Dads Referral

Filling out the Dads Referral form is an essential process for reporting suspected provider fraud within the Texas Department of Aging and Disability Services. This guide provides clear, step-by-step instructions to help users complete the form efficiently and accurately.

Follow the steps to successfully complete the Dads Referral form.

1. Press the ‘Get Form’ button to acquire the Dads Referral form and open it in your preferred editor.
2. Begin filling out the contact information for the DADS staff submitting the referral. Provide the name, title or position, DADS Area, State Office, Region number, and the office street address. Ensure all fields are completed accurately.
3. Fill out the contact information for witnesses with information about the suspected fraudulent activity. This includes individual names, relationships to the provider, phone numbers, and physical addresses as necessary.
4. Indicate whether a law enforcement agency has been notified about the suspected fraud. Provide the name of the agency, individual contacted, and their contact information, along with any case numbers, if available.
5. Complete the provider information section. This includes the name of the legal entity, Texas ID number, contract number, doing business as name (if applicable), license number, and physical address along with contact information.
6. Select the type of provider from the provided list. This helps categorize the referral and aids in processing it correctly.
7. Describe the type of suspected fraudulent activity and provide the date or date range. Choose the type of review that pertains to the suspected fraud.
8. Answer the review information questions regarding the total sample size, individuals served, and whether fraudulent activity was suspected beyond the review period.
9. Provide any additional information regarding technical assistance received by the provider on billing within the past two years.
10. In the description of suspected fraudulent activity section, provide a detailed account of the observed issues. This information is crucial for the investigation process.
11. Answer questions about the impact of payment suspension on displaced individuals and provide any additional explanations as needed.
12. Once the form is fully completed, you can save your changes, download, print, or share the completed form as necessary.

Take action today by completing the Dads Referral form online.