Data drives efficiency, productivity

The OIG continues to refine its capabilities to make its work data-driven. This enables the OIG to pinpoint areas where fraud, waste and abuse are happening and target cases with the highest potential for recoveries.

During fiscal year 2020, the OIG began working with a new vendor for its Medicaid Fraud and Abuse Detection System (MFADS), a database used to perform key analytical research and ad hoc query-reporting capabilities to assist in prevention efforts. The move allows the OIG to maintain operations, integrating data assets and advancing analytical processes.

The Fraud, Waste and Abuse Research and Analytics unit completed phases of enhancements that significantly speed analytics processes that support data mining of Medicaid claims for potential fraud, waste or abuse. For example, a data query of 21 million dental services previously took 11.5 hours to return; it now takes slightly more than 10 minutes. These advancements improve the timeliness of monitoring billing trends, which is critical to detecting emerging concerns. The unit also worked with the Nursing Facility Utilization Review (NFUR) team to revamp its risk assessment process to achieve faster and more comprehensive results. The new framework better highlights facilities that scored high on several risk factors, allowing NFUR to better prioritize its work.

The OIG is also working with the Texas Department of Licensing and Regulation to integrate license and supervisory relationship data for speech language pathologists and audiologists; integrating the data will enhance OIG analytics and detection of potential program violations.