Mental Health, Mental Retardation, Crisis Services, Harris County Houston, Texas

INTERNAL AUDIT DEPARTMENT

Report Allegation of Fraud

Fraud (Definition): Financial irregularities and illegal acts characterized by intentional deception.

Perpetrated for the benefit of or to the detriment of the MHMRA of Harris County.

By persons outside as well as inside the MHMRA.

The MHMRA (Internal Audit) is committed to eliminating fraud and waste. If you are aware of fraudulent activities being committed by MHMRA employees or officials, citizens, or business entities defrauding the Authority, you can help save taxpayer money by furnishing this information to the Internal Auditor. Please provide any information you may have to the contact number listed below.

	1-800-826-6762	(English)
	1-800-297-8592	(Espa�ol)

Identify the type of fraud you are reporting, e.g. theft of goods or services by an official or employee.

Choose from the following:

Official / Employee:

Please provide a precise description of the fraudulent activity, including the name of any MHMRA Department/Unit, Program or Service wherein you believe fraud is taking place; the name of the individual or business entity whom you believe is involved in fraudulent activity; and details of the incident(s) you are reporting.

If these allegations are related to a claim or to a contract, please provide the claim or contract number, if known.

Date the incident occurred:

Where the incident occurred:

What is the basis of your knowledge regarding these matters (e.g. you witnessed these acts first-hand; you work where the fraud is occurring; you have been told by others with first-hand knowledge; etc.)?

Do you have any evidence such as documents, photographs, letters, electronic data, or anything else to substantiate the fraud? Describe.

Can we contact you to discuss your concerns in more detail?

Yes No

If yes, please provide a way we can contact you below. (You may provide as much or as little information as you wish.)

First Name:
Last Name:
Address:
City:
State:
Zip:
Phone:
Email:

Would you be willing to come into our office to give a statement?

Yes No