OIG settles cases with multiple providers
During the fourth quarter of fiscal year 2021, the OIG settled cases in multiple health care categories, beginning the process of recovering funds for the state of Texas.
The OIG Litigation team works collaboratively with providers looking to resolve pending cases, like two private duty nursing providers in Houston and San Antonio that had been improperly reimbursed for more than the maximum allowable amount for certain clients. In these cases, the providers cooperated with the OIG agreeing to settlements of $108,567 for the Houston-based provider and $73,916 for the provider in San Antonio.
Some settlements are the result of billing errors or a misunderstanding of the proper reporting procedures involved in a service.
The OIG encountered this while working with a Mesquite-based pediatric care provider. The provider’s error involved separately billing for audiometry services that were included as a bundled component of the Texas Health Steps preventative care visit. The provider worked collaboratively and cooperatively with the OIG to identify the extent of the error and heighten their understanding of proper billing procedures to prevent similar errors from occurring in the future. The provider also agreed to a settlement of $330,000.
Not all OIG settlements involve repayments for errors in billing, some also involve penalties for violation of program rules or policies. In July 2021, the OIG pursued a case against an Arlington pediatric care provider. The case focused on allegations of Medicaid client solicitation and erroneous billing. To resolve the matter the provider agreed to settle for $50,000, which included $15,000 in penalties for violation of program rules. The provider closed the practice at the end of 2019; however, he was still able to work with the OIG to improve his understanding of applicable statutes and Texas Medicaid policies and provisions to prevent future errors.