Texas Fraud Prevention Partnership builds connections with managed care organizations

The OIG continues to prioritize formal discussions with the Texas Medicaid and CHIP MCOs through the Texas Fraud Prevention Partnership (TFPP). Sharing information between the OIG and the MCOs in group meetings and individual sessions promotes collaboration around program integrity work and supports evaluating areas for future improvements and coordination.

OIG leadership met with executive leadership from MCOs three times during fiscal year 2021 to discuss current initiatives and combined efforts to prevent, detect and investigate fraud, waste, and abuse. These meetings covered such topics as: fraud, waste and abuse trends associated with the COVID-19 pandemic; issues related to current and upcoming OIG audits; updates on hospital and nursing facility utilization reviews; and discussions around data requests and related technical assistance.

The OIG also held individual meetings with executive leadership from each MCO and DMO. The meetings included discussions regarding the operation of each MCO’s compliance program; special investigative unit organizational structure and resources; and challenges and best practices in identifying fraud, waste and abuse.

TFPP special investigative unit (SIU) meetings are held three times each year with MCO SIUs and the Attorney General Medicaid Fraud Control Unit to share insights and information. The OIG also holds one-on-one meetings with SIU staff at the largest MCOs to discuss their investigations and current trends in fraud, waste and abuse.

Learn more about this and other initiatives in the Quarterly Report.