To increase speed and accuracy in detecting fraud, waste and abuse (FWA), the OIG has focused on growing the agency’s data analytics toolset and processes available to investigators.
OIG recently inspected payroll records from a skilled nursing facility in the greater Houston area to determine if the hours of direct care provided by licensed nursing staff were accurately reported.
The Texas Health and Human Services Office of Inspector General (OIG) works with Texas pharmacists to prevent and investigate fraud, waste and abuse in Medicaid and CHIP services.
The OIG Fraud Hotline reported 7,602 contacts in the first quarter of fiscal year 2023. They subsequently referred 1,762 allegations for further investigation or action to the appropriate OIG division.
During the first quarter of fiscal year 2023, the OIG's Electronic Benefits Transfer (EBT) Trafficking team completed 107 cases investigating retailer fraud in the Supplemental Nutrition Assistance Program.
A recent audit on the state's Medicaid enrollment broker found that most requirements related to communicating and processing enrollment information were met; however, some processes had room for improvement.
The Texas health care community plays a critical role in preventing prescription misuse through the Medicaid Lock-In Program (MLIP), administered by the OIG.
OIG inspectors recently reviewed records from a skilled nursing facility to determine if the hours of direct care provided by licensed nursing staff were accurately reported.
The goal of the OIG’s work in nursing facilities is to support patient care and ensure the proper expenditure of Medicaid dollars.
An OIG audit of a managed care organization (MCO) found issues related to the documentation and inclusion of certain expenses in their combined financial statistical report (FSR).