OIG Medicaid Program Integrity recovers $14 million in third quarter

The Medicaid Program Integrity (MPI) Division is comprised of Provider Investigations, Medical Services, Program Integrity Development and Support and the Provider Enrollment Integrity Screenings units. A full description of the teams is posted here. Among these teams, MPI recovered $14 million during the third quarter.

A number of cases investigated by MPI were settled by the Office of Inspector General (OIG) Litigation team. Some of those cases include the following:

After-hours services settlements. The OIG reached a settlement in March with a physician in Pharr for $297,549. The investigation determined that the provider was reimbursed for after-hours services when reimbursement was not appropriate. After-hours services include office visits and other services which are reimbursed at a higher rate than services provided during regular business hours. In a similar after-hours case, OIG settled in March with a physician practice in Mission for $61,310.

Durable medical equipment settlement. The OIG reached a settlement with a durable medical equipment provider in Corpus Christi. The investigation found that the provider violated Medicaid policy by failing to maintain proof of delivery slips for spacers and to maintain documentation to support items billed. OIG reached a settlement with the provider in April for $119,099.

Dental provider settlement. The OIG reached a settlement with a dental provider in Garland who was found to have been reimbursed for medically unnecessary services. Allegations against the provider included extractions of teeth that would have shed on their own and overutilization of x-rays. The provider also failed to maintain adequate documentation for services billed and billed for services that are non-reimbursable by Texas Medicaid. The provider also was alleged to have wrongfully solicited patients in violation of Medicaid policy. OIG reached a settlement in March for $150,000.

You can read more about the OIG’s work during the third quarter by reading the OIG Quarterly Report here.