Longest-serving employees mark OIG anniversary

Recently, members of the Texas Health and Human Services (HHS) Office of Inspector General (OIG) gathered at the agency headquarters in Austin to celebrate 20 years of service to Texas. The event brought together employees from around the state and provided training seminars and informational sessions on a wide variety of topics. The event also recognized the efforts of individual employees and teams who excelled in the agency's mission over the last quarter. To conclude the event, Inspector General Raymond Charles Winter hosted a presentation recognizing the 12 team members who were with the agency when it began operations in 2004 and continue to serve with the OIG. Their commitment to serving the state has endured for two decades, so we asked them to share their thoughts about the OIG in our last quarterly report. Here’s what they had to say:

As the director of investigations and reviews for Electronic Benefits Transfer (EBT) trafficking and WIC, Andy Abrams well understands the people served by vital HHS programs. "The work that I have been a part of for the last 20 years directly impacts people's lives. Tax dollar oversight is important, as is making sure that the people who are being served are properly served. But the best part about working at the OIG is making a difference in the lives of those who are marginalized and somewhat rejected by the systems."

OIG Benefits Program Integrity (BPI) prosecutes recipients who commit fraud. "BPI's work is essential in the fact that we recover fraud overpayments, and by doing so, often deter fraudulent activity by getting the word out that fraud against the program is a state jail felony, and the agency takes action," says BPI manager Norra Kost-Lambert. "Just as important, our job often times is to determine an individual did not commit a crime or have an overpayment and, therefore, is innocent of the fraud allegations."

The personal results of the work drew many people to the OIG. And it's kept them here. Protecting HHS program integrity helps ensure that assistance is available for the vulnerable families who truly need it.

Medicaid Program Integrity (MPI) management analyst Patricia Nascimento explains, "If the OIG did not exist to do the work we do, there would be no or little accountability for the use of taxpayer dollars and to protect Texas beneficiaries from actions that can cause them harm." "The work we do helps more recipients to receive benefits," adds Maryann Magovern, an administrative assistant in Abilene's regional office.

"In a world that seems to desire instant gratification, even if it means being fraudulent, I think it's important to say being fraudulent is not right," says research specialist Eugene Sánchez with the Targeted Queries team.

In fiscal year 2023, OIG teams recovered $532 million in misspent tax dollars. Returning billions of tax dollars to the state since 2004 is only part of the agency's track record of success. A continued focus on educating and collaborating with providers has helped to prevent waste and wrongdoing from happening in the first place.

"I have worked for many different Inspectors General and seen a lot of changes, but the overall vision and mission have always been very similar. We work side-by-side with a common goal to ensure our success," explains management analyst Ada Porter, with Recovery Coordination and Program Support. "But the biggest change has been technology; it has changed how we communicate, learn and think."

Since its inception, the OIG has evolved into a data-driven agency, employing top talent to create algorithms, analyze results and successfully complete cases. OIG advancements have improved the early detection of questionable behavior and the identification of industry-wide trends. For example, the OIG's Fraud Analytics team developed a predictive model to identify potential waste and wrongdoing using artificial intelligence. The team trained the supervised machine learning model to identify risky providers using examples of providers that are currently excluded from participating in the Texas Medicaid program. The model helps uncover questionable behavior and highlight claims for closer review. Throughout fiscal year 2024 and beyond, our stakeholders can expect to see continued innovation in Medicaid fraud prevention and detection.

While leveraging the latest technology and tools helps drive the OIG forward, the secret to two decades of continuous improvement lies with the talented employees who put the OIG's values – accountability, integrity, collaboration and excellence – into practice.

BPI investigator Bonny Bryson shares, "The best part of working here is being a member of this team. I've seen OIG evolve and improve, and I'm thankful that I've been part of that."

The OIG is grateful for the collaborative relationships forged over the years with our stakeholders. The continuing commitment of thousands of providers and hundreds of OIG team members across the state helps create a healthier Texas for everyone.

"No one wants to hear from us, but our staff are dedicated and committed," explains training advisor Todd Shaw. "The OIG positively impacts both recipients and providers by being vigilant to abuses in the system. It protects and gives back, usually without fanfare or acclaim, and does so year after year."