Operations Division

Third Party Recoveries for fiscal year 2021. Quarter 1: $60,856,579. Quarter 2: $56,435,081. Quarter 3: $92,307,191.

The Operations Division is comprised of six core functions:

Purchasing and Contract Management helps to ensure compliance with HHS purchasing and contracting laws, rules and policies by coordinating with HHS procurement and contracting team and OIG divisions throughout the procurement and contracting lifecycle and processing of invoices prior to submission to Accounts Payable.

The Fraud Hotline receives allegations of fraud, waste and abuse, screens them and refers them for further investigation or action as appropriate.

Finance and Budget oversees the OIG budget, tracks recoveries, reports Legislative Budget Board performance measures and works closely with HHSC Central Budget on the agency’s LAR/Exceptional Items.

Program Support and Training promotes OIG training services and internal OIG operational policy development.

Third Party Recoveries (TPR) works to ensure that Medicaid is the payer of last resort, which requires that Medicaid recipients use all other resources available to them (e.g., private health insurance, automobile insurance) to pay for all or part of their medical care before billing Medicaid. TPR also operates the Medicaid Estate Recovery Program.

The Ombudsman provides an independent and neutral process for OIG employees to address concerns and work towards resolution.