About IG

The role of IG

In 2003, the 78th Texas Legislature created the Office of Inspector General to strengthen the Health and Human Services Commission's capacity to combat fraud, waste, and abuse in publicly funded state-run Health and Human Services programs.

The IG's mission, as prescribed by statute, is the "prevention, detection, audit, inspection, review, and investigation of fraud, waste, and abuse in the provision and delivery of all health and human services in the state, including services through any state-administered health or human services program that is wholly or partly federally funded, and the enforcement of state law relating to the provision of these services."

Our primary tools for detecting, deterring, and preventing fraud, waste, and abuse are audits (conducted under the federal "Yellow Book" standard); investigations (conducted pursuant to generally accepted investigative policies); and inspections (conducted under the federal "Silver Book" standard).

Defining fraud, waste, and abuse

Fraud: Any act that constitutes fraud under applicable federal or state law, including any intentional deception or misrepresentation made by a person with the knowledge that the deception could result in some unauthorized benefit to that person or some other person.  Fraud may include any acts prohibited by the Texas Human Resources Code, Chapter 36 or Texas Penal Code, Chapter 35A.

Waste: Practices that a reasonably prudent person would deem careless or that would allow inefficient use of resources, items, or services.

Abuse: Practices that are inconsistent with sound fiscal, business, or medical practices and that result in unnecessary program cost or in reimbursement for services that are not medically necessary, do not meet professionally recognized standards, or do not meet standards required by contract, statute, or regulation.

Our Principles

Be the best state-level IG in the country.

Professionalism. Productivity. Perseverance.

To detect, prevent, and deter fraud, waste, and abuse through the audit, investigation, and inspection of federal and state taxpayer dollars used to deliver health and human services in Texas.

Strategic Plan

Identify and eliminate fraud, waste, and abuse through timely, quality audits, investigations, and inspections.

Generate and disseminate excellent work products that demonstrate mission performance, inform our stakeholders, and educate the citizens of Texas.

Identify and implement best practices in all areas of the organization.

Develop and maintain outstanding internal and external relationships to promote transparency and accountability in all we do.

Develop an outstanding team committed to pursuing excellence in all we do.

Maintain and improve business support functions to promote the success of our mission.

Measuring Success

Defining fraud, waste, and abuse

Fraud: Any act that constitutes fraud under applicable federal or state law, including any intentional deception or misrepresentation made by a person with the knowledge that the deception could result in some unauthorized benefit to that person or another person.

Waste: Practices that a reasonably prudent person would deem careless or that would allow inefficient use of resources, items, or services.

Abuse: Practices that are inconsistent with sound fiscal, business, or medical practices and that result in unnecessary program cost.

In fiscal year 2016, IG:

Recovered $85 million, a 40 percent increase over FY 2015.

Identified another $65.5 million in potential recoveries.

Secured more than $5.7 million in settlements.

Issued 50 Audit reports.

Processed more than 96,000 Medicaid enrollment screenings.