Texas providers continue to self-report overpayments

More providers are participating in the OIG self-report process so they can determine if they need to disclose overpayments received from participation in Texas Health and Human Services (HHS) programs. The OIG developed guidance for health care providers choosing to voluntarily disclose irregularities related to Medicaid claims and other HHS programs. The OIG views the program as a way to collaborate with providers, allowing the state to reduce fraud, waste and abuse while offering an opportunity for providers to potentially reduce their legal and financial exposure. Working with the OIG may also lead to providers better understanding the OIG's audit and investigatory processes. The following cases are examples of recent self-reported cases: 

  • The OIG settled a case in January against a Dallas hospital provider after the hospital conducted its own internal investigation and discovered that the hospital was billing for outpatient and inpatient renal dialysis for patients who did not qualify for Medicaid. The provider proactively self-reported the incident and collaborated with the OIG to resolve the situation. The provider correctly reported that it owed the Medicaid program $5,521,578 and took corrective action.
  • The OIG settled a case in February involving a South Texas adult daycare provider. The provider determined that it had failed to have at least one registered nurse (RN) or licensed vocational nurse (LVN) working at the facility for at least eight hours per day. The provider erroneously billed for and received payment for services for days that at least one RN or LVN was not at the facility for at least eight hours. The provider reported the errors to OIG and worked collaboratively with OIG Litigation to resolve these issues. The OIG agreed to a settlement of $111,617.
  • The OIG settled a series of self-reports in December and January with a Richardson home health care provider who through an internal investigation discovered that six caregiver-employees caused services to be billed that were not rendered over various, unrelated time periods. For the six self-reports, the provider correctly reported that it owed the Medicaid program a total of $7,221. They agreed to resolve the claims in question through settlement.