OIG responds to COVID-19 pandemic

When Governor Abbott issued his disaster declaration on March 13, the OIG took steps to ensure that the agency continued its work while helping our stakeholders in the time of uncertainty.

The OIG deployed technology to allow staff to work from home to ensure their safety. The agency also adjusted reporting deadlines for providers and managed care organizations to help them focus on patients. Staff across the OIG quickly responded to emerging fraud, waste and abuse schemes during the pandemic.

Assisting providers

To assist providers in maintaining focus on their patients, the OIG changed a variety of processes and extended timeframes for information and data requests and management responses. The Audit and Inspections Division paused new audits and inspections between March 19, 2020 and May 1, 2020. Medical Services in March halted onsite nursing facility reviews and notified providers that deadline extensions were granted for medical records requests, reconsiderations and identified recoupment payments. While new audits and inspections are now proceeding, our teams are working carefully to ensure minimal impact to audit clients whenever possible. The OIG continues to work closely with all audit clients to extend response times when needed. The OIG is utilizing virtual meeting technology to conduct audit and inspection interviews, walk-throughs and testing.

OIG Fraud Hotline

Providing continuity of service for the Fraud Hotline was a priority when the OIG transitioned employees from working in the office to working at home during the pandemic. Operations staff quickly deployed new software and training to allow all Fraud Hotline staff to telework.

Staff continue to answer calls concerning fraud, waste and abuse and route the resulting reports to investigations as appropriate. The Fraud Hotline answered 5,491 calls during the third quarter of fiscal year 2020, with an average wait time of 25 seconds.

Fraud alerts and educational guides

The Medicaid Program Integrity Division (MPI) collaborated with OIG’s Communications Team to launch a COVID-19 fraud alert section on the OIG website and publish warnings on social media about the various COVID-19 FWA schemes and how to avoid becoming a victim.

With the increase of benefit applications due to COVID-19’s effect on the economy, the OIG produced web content to further educate applicants and benefit recipients on the appropriate use of SNAP, Medicaid and Temporary Assistance to Needy Families benefits. The electronic resources provide clients with tips on how to properly apply for benefits with accurate information, examples of misusing benefits, and contact information for reporting suspected FWA. In addition, information for SNAP retailers was included to help prevent benefits trafficking. The new guides are available in English and Spanish; they are posted on the OIG website’s resources page.

WIC digital technology

In response to COVID-19, the Women, Infants and Children (WIC) Vendor Monitoring Unit adjusted their mission to increase the number of remote inventory audits. The remote audits were in place of the in-person covert compliance buys and on-site overt store reviews typically used to ensure vendors are following WIC rules. An inventory audit compares a vendor’s paid claims and purchase invoices to determine if the vendor had a sufficient inventory of WIC food items to justify their submitted claims.

The OIG WIC team now uses digital technology to remotely access individual vendor redemptions to initiate inventory audits.

Going forward

The Policy, Development and Innovation team is working with the Data and Technology Team to identify and evaluate emerging trends in healthcare service delivery and administration related to COVID-19. The team is reviewing published reports and identifying focal points for data analysis related to program integrity during the pandemic.

Throughout the course of the pandemic, the OIG has and will continue to adapt to events, anticipate their results and take action to support health care delivery in Texas.