OIG holds individual meetings with special investigative units

Recently, the OIG met with some of the state’s largest managed care organization’s (MCO’s) in-house investigators, known as special investigative units (SIUs). The meetings were part of the Texas Fraud Prevention Partnership (TFPP), which brings agency stakeholders together to discuss emerging trends in health care fraud and best practices for countering the constantly evolving methods used to defraud Medicaid.

TFPP holds group meetings three times per year where the OIG, SIUs and the Texas Attorney General’s Medicaid Fraud Control Unit share their experiences to identify trends in Medicaid fraud. Additionally, MCO’s meet individually with the OIG to share specific information about pending investigations and case referrals.

The information gained from these collaborations provides the OIG with a starting point to identify statewide issues. OIG investigators can expand the findings of a single SIU across multiple MCOs to determine if irregularities appear in a provider’s claims.

SIUs are a contractual requirement for MCOs, and the teams must include a full-time SIU manager and credentialed investigator who identifies fraud, waste or abuse by providers. The OIG supports these efforts through routine audits that verify SIUs are providing training, have the appropriate staffing and meet reporting deadlines.