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Medicaid providers are increasingly using the OIG’s self-report process to resolve cases.

The Benefits Program Integrity (BPI) division completed 4,203 investigations involving some form of benefit recipient overpayment or fraud allegation in the fourth quarter of fiscal year 2020.

The OIG continues to refine its capabilities to make its work data-driven.

The OIG completed an audit of Parkland Community Health Plan, a Texas Vendor Drug Program (VDP) Provider, and its subcontracted Pharmacy Benefits Manager, Navitus Health Solutions.

The OIG’s work to uncover fraud, waste and abuse in health care delivery often begins with referrals from MCOs, providers and clients.

Sentencing continues in a benefits trafficking case that produced criminal charges against 62 defendants.  The OIG’s EBT Trafficking Unit partnered with local law enforcement on the investigation.   

The OIG Fraud Hotline answered 7,827 calls during the fourth quarter of fiscal year 2020 (FY 20), with an average wait time of 44 seconds.

The OIG has updated its Rolling Audit and Inspections Plan for fiscal year 2021, which outlines potential audit and inspections areas and topics.

The audit assessed the design and effectiveness of selected security controls over confidential HHS System information stored and processed by Aetna Better Health of Texas.