Ig Integrity Initiative Pledge Form - Texas Health And Human Services Commission Page 2

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IG Integrity Initiative
Inspector General
Texas Health and Human Services Commission
IG Integrity Initiative Pledge
1) Our Mission or Values Statement includes our commitment to integrity in all aspects of our
participation in the Texas Medicaid Program.
2) We commit to report to the IG any suspected Medicaid fraud, waste, or abuse whenever or
wherever we encounter it.
3) We commit to train and support all our staff regarding compliance with Texas Medicaid rules
and regulations.
4) We commit to posting IG Integrity Line posters in all high traffic areas and to including a link on
our website to the IG's website.
Printed Name of Medicaid Provider
Signature of Provider or Authorized
Representative
National Provider Identifier/Texas Provider Identifier
Printed Name & Title of Authorized
Representative
Date Signed:

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