OIG secures $7.2 million in settlements with two statewide hospital systems for improper emergency department billing
The OIG has agreed to resolve cases with two hospital systems after claims data showed each had received millions in improper reimbursements.
Telehealth billing errors lead to overpayment
The OIG conducted an audit that found a Houston-area mental health and intellectual and developmental disabilities provider incorrectly billed Medicaid for some teleservices, leading to overpayments.
MCOs did not properly document all non-covered services in financial reports
Two Texas MCOs improperly coded some case-by-case services in their Financial Statistical Reports for fiscal year 2022.
Invoice reconciliation keeps Medicaid-enrolled pharmacies in compliance
Pharmacy invoice reconciliation investigations ensure that claims submitted to Medicaid are consistent with medication purchase records.
Inconsistent data found in MCO’s provider appeal reports
A recent inspection found that submitted reports about the timeliness of provider appeals did not always match detailed reports in the managed care organization’s archives.
First Quarterly Report of fiscal year 2025 released
The Office of Inspector General published its first quarterly report for fiscal year 2025, with performance metrics, case summaries and agency highlights.
Fort Worth pharmacy overpaid for some Medicaid client prescriptions
A recent audit conducted by the OIG found a pharmacy was overpaid for prescriptions dispensed to Texas Medicaid and Children’s Health Insurance Program (CHIP) members.
Pharmacy benefit manager uses unallowable pricing model
Despite being refused access to necessary records, OIG auditors uncovered evidence that a pharmacy benefit manager used an unallowable pricing model that resulted in spread pricing.
Dental cases review offers insight in avoiding billing and compliance issues
Education and prevention are essential tools the OIG uses to avoid fraud, waste and abuse. To assist dental providers the agency is providing two case studies, one in record keeping and another in solicitation.
Guard Your Card
The week before Thanksgiving is the busiest time of the year for American grocers, which means more opportunities for scammers.