OIG reports fraud hotline results for fourth quarter of fiscal year 2022
The OIG Fraud Hotline handled 7,841 calls and other points of contact in the fourth quarter of fiscal year 2022 with operators referring 1,844 cases for further investigation. The hotline provides a phoneline and web-based process for the public to report suspicious behavior involving a health care provider or client who may be abusing Medicaid benefits. Of the contacts received, hotline staff referred the following case types to investigators.
- Benefit recipients 1,472
- Medicaid provider 145
- HHS employee/contractor 54
- EBT retailer 171
- State Supported Living Center/State Hospital 2
When contacting the hotline users are 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.