The Chief Counsel Division provides legal counsel to the Inspector General and the IG Divisions: Investigations, Audit, Inspections, Medical Services, Provider Enrollment, and Operations. Chief Counsel Division attorneys advise and support the IG Divisions so that each division is best able to accomplish the IG mission: detecting and preventing - through investigation, audit, inspection, or review - fraud, waste, and abuse in the provision and delivery of all health and human services in the state. The IG Chief Counsel Division works collaboratively with the HHSC Chief Counsel Division to provide legal support for administrative functions appropriately coordinated, as described by HB 2379 passed by the 85th Legislature.
The Litigation section handles the appeal of investigations and audits that have determined providers have received Medicaid funds to which they were not entitled. These investigation cases are settled by agreement or resolved by trial before a State Office of Administrative Hearings (SOAH) Judge. Audit files are settled by agreement or resolved by trial before a HHSC-Appeals Judge. The Litigation section also initiates and processes provider enrollment terminations and exclusions against Medicaid providers for certain program violations. Finally, the Litigation section works with providers when they want to self-report a potential Medicaid violation.
The General Law section provides legal advice and support to all aspects of the Inspector General’s operations, including researching termination/exclusion issues, drafting policies and procedures, determining federal share obligations, analyzing extrapolation processes, contracting with local prosecutors, and proposing rule and statute changes. The general law section is responsible for taking initial actions related to terminating or excluding providers when required by federal law, such as when a provider has been terminated or excluded from Medicare or another state Medicaid program.
Link to Texas Medicaid Fraud Control Unit.