The Investigations Division protects the integrity of the Texas Medicaid and other health and human services programs through investigations of provider and recipient fraud, waste, and abuse. It also analyzes trends and patterns of behavior and billing and refers cases for sanctions or prosecution to appropriate state or federal regulatory and law enforcement authorities. Additionally, the Investigations Division conducts personnel investigations at the State Supported Living Centers as well as within the HHS system.
The Investigations Division has five separate directorates: Medicaid Provider Integrity; General Investigations; Law Enforcement; Internal Affairs; and Training.
Medicaid Provider Integrity
MPI investigates allegations of fraud, waste, and abuse committed by Medicaid providers. Some referrals come through the IG Integrity Line or complaints from the Inspector General’s online Waste, Abuse and Fraud Electronic Referral System. Referrals are also received from the 23 managed care organizations (MCOs) throughout the state.
MPI makes referrals to the Attorney General's Medicaid Fraud Control Unit (AG-MFCU) when there are indicators of criminal Medicaid fraud. MPI and AG-MFCU work together on joint investigations by sharing resources and information that will lead to successful administrative or criminal prosecution.
GI conducts investigations of state publicly funded health and human services recipients. Specifically, it pursues allegations of overpayments made to recipients in the Supplemental Nutrition Assistance Program; Temporary Assistance for Needy Families; Medicaid; Children’s Health Insurance Program; and the Women, Infants, and Children program.
Law Enforcement consists of both commissioned and non-commissioned investigators who conduct criminal investigations surrounding violations involving State Supported Living Centers and State Hospitals, and Electronic Benefits Transfers. The two units comprising this directorate are the State Centers Investigative Team, and the Electronic Benefit Transfer Trafficking Unit.
IA conducts investigations of fraud, waste, abuse, employee misconduct, and contract fraud within the HHSC system.
The Training directorate works closely with the IG's Professional Development team to develop investigations-specific training to increase investigative knowledge and skills.