OIG Third Party Recoveries enhances efficiencies with MCOs

Third Party Recoveries (TPR), part of the OIG's Operations division, recovered more than $56 million for Texas taxpayers in the second quarter of this fiscal year. The unit continues to collaborate with HHS and Texas Medicaid and Healthcare Partnership (TMHP) to strengthen and improve Third Party Liability (TPL) activities performed by MCOs.

During the first two quarters of fiscal year 2021, the OIG and TMHP initiated several projects to help MCOs coordinate benefits to ensure Medicaid is the payer of last resort. TPR and TMHP conducted trainings and provided technical assistance to help MCOs better understand TPL activities. The OIG has met individually with MCOs and providers to discuss improvements to the TPL process that will assist in coordinating benefits. TMHP increased the frequency of information flowing to MCOs to ensure they receive current, accurate other-insurance records to maximize cost avoidance and cost recovery efforts.

TPR identified nearly $43 million in future recoveries in the second quarter and realized a cost avoidance of more than $31 million through front-end claims denials.