Reflecting on Inspector General Winter’s first year at the OIG

What were your main goals when you first assumed the role of Inspector General, and how have they evolved over the past year?

My primary goal remains the same: to enhance the OIG’s effectiveness in protecting the integrity of the Texas Health and Human Services system. Building on former Inspector General Kauffman’s legacy, I would like the OIG to continue improving our outcomes in areas such as negotiating case settlements for value and holding wrongdoers accountable at a level appropriate for the transgression.

Our mission is to safeguard the interests of Texas taxpayers by resolving cases that return value to the state. Each case is assessed on its impact on the state, the conduct of the wrongdoer and the broader implications for public health. For cases involving severe violations, I intend to pursue administrative hearings to exclude bad actors, recover public funds and create an effective deterrent to future violations. We will continue working to achieve these goals as we head into the next year and beyond.

Can you share specific examples where the OIG has directly impacted the efficiency or integrity of Texas Health and Human Services?

Our Data Initiatives Project Team (DIPT) has made significant strides in detecting provider misconduct, such as double billing, using data analytics. Our data scientists create and run algorithms to identify anomalies in billing, which are suggestive of errors or misconduct by providers based on how they bill the state, subject to further investigation. The resulting collaboration between OIG analysts, investigators and attorneys has led to substantial recoveries from Medicaid providers. Since its inception in 2015, the DIPT team has recovered approximately $73 million as a result of these initiatives, including millions in this fiscal year alone.

Similarly, our Medicaid Program Integrity team has begun numerous successful initiatives such as pharmacy invoice investigations, which are focused on identifying pharmacies that billed for more medications than they purchased or billed for more expensive, branded drugs while dispensing generics. These targeted initiatives are critical to ensuring providers do not take advantage of the system, and I look forward to progressing more similar initiatives in the future as we look into different billing behaviors by a wide variety of provider types.

What are your thoughts on professional development and collaborative opportunities for OIG staff, and what is your vision for the future?

We should continue to take advantage of opportunities to send OIG subject matter experts to conferences and events where they can receive training on new techniques, learn about relevant schemes and build relationships with other enforcement agencies across the country. I applaud those who have taken advantage of these opportunities, especially as they return to share what they have learned with colleagues. This strengthens our collective knowledge and allows us to better protect health and human services in Texas. It also allows us to share our formidable knowledge base with others, thereby helping safeguard Medicaid and other programs on a much broader level. Internal collaboration will also be critical. There is already a great framework in place for this within the OIG, but continuing to foster cross-divisional collaboration and the early involvement of the legal team on certain, strategic cases is one of my top priorities.

What excites you most as you continue into your second year as Inspector General?

We work continually to increase our recoveries and improve upon our return of value to taxpayers, so I am particularly excited about the upcoming legislative session. Running only from January through May every other year, the legislative session is always demanding, but it provides a fantastic opportunity to showcase the incredible efforts of our team. It is also when we get to collaborate with our lawmakers to grow and adapt to the needs of a changing health care landscape. To remain effective, we must keep pace with emerging technologies, trends and, sadly, schemes to game the system. We have learned a lot over the last 20 years of the OIG’s existence, and I am looking forward to working with the legislature as we prepare for future challenges.

What key takeaways would you like readers to know about your first year in office?

The OIG’s scope is far broader than I knew before assuming the role of Inspector General. Our work spans not just Medicaid, but every HHS program and encompasses health care providers, benefit recipients, retailers, and HHS employees and contractors. From audits to specialized investigations, data analysis and much more, the OIG possesses incredibly advanced mechanisms to help carry out our mission. I’ve been continually impressed by the talent level and dedication of our staff. By combining the expertise of our staff with the tools that the legislature has given us, we will continue to do our jobs more effectively to return value to Texas taxpayers and better protect the clients we serve. There is always more work to be done and more opportunities for improvement, but seeing the OIG’s capabilities firsthand gives me great confidence that we are carrying out the mission thoroughly, fairly and to great effect for the citizens of Texas.

Any final thoughts?

I want to emphasize how proud I am of our immensely talented and dedicated staff. We are all here because we believe in public service, giving back to our communities and doing what is right for Texans. I am incredibly grateful for the hard work of our staff and excited for what’s to come!