OIG reports fraud hotline results

The OIG Fraud Hotline handled 5,995 calls and other points of contact in the second quarter of fiscal year 2022. The hotline is an avenue for the public to report suspicious behavior involving a health care provider or client who may be abusing Medicaid benefits.

The OIG also handles cases involving improper action by Texas Health and Human Service (HHS) employees or contractors or additional concerns about the administration and operation of HHS programs.

When calling the hotline, you will be asked basic questions about the allegation to determine if a complaint needs further investigation. If the complaint contains enough information, a case is opened and assigned to an investigator. The investigator determines whether a complaint represents a violation of Texas Health and Human Services 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 education; referred to another agency or entity; or referred for a full-scale investigation.

In the second quarter, hotline staff sent 1,478 reports from those calls for further investigation or action to the appropriate OIG division. Another 1,457 callers were referred to another area in HHS, 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:

Referral Type      

Total for Second Quarter

Benefit Recipient 1,298
Medicaid Provider 102
HHS Employee/Contractor 27
EBT Retailer 50
State Supported Living Center or State Hospital 1

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