OIG releases Fraud Hotline results for second quarter

The OIG Fraud Hotline answered 4,815 calls in the second quarter of fiscal year 2021. Providers, staff, clients and the public may call to report observations of other providers, suspicious corporate behavior or a Medicaid beneficiary who may be abusing benefits.

Initial calls include basic questions about the allegation and determine if a complaint needs further investigation. If the complaint is Medicaid-related and contains sufficient information, a case is opened and assigned to an intake investigator. The investigator determines whether a complaint represents a violation of Medicaid policy or federal/state law or regulation. Based on the findings of a preliminary investigation, a case may be closed; concluded with a recommendation for provider education; referred to another agency or entity; or referred for a full-scale investigation.

In the second quarter, hotline staff sent 1,338 reports from those calls for further investigation or action to the appropriate OIG division. Another 1,029 callers were referred to another area in Texas Health and Human Services, another state agency or to another entity that could better address their concerns. Here is a breakdown of the types of referrals made by the hotline during the second quarter:

You can report suspected benefits fraud or misuse by calling 800-436-6184 or visiting ReportTexasFraud.com.