The El Paso Benefits Program Integrity (BPI) team is part of a task force honored as “Best Team” by Homeland Security Investigations.

A self-report by a provider to both the federal OIG and Texas OIG led to a successful collaboration between the agencies to achieve a settlement agreement for $7,000,000.

Under the agreement executed in May, Texas will receive $1,400,000 to be paid semi-annually over seven years. The remaining amount will be collected by the federal government.

The provider from Gaines County self-reported improperly paying physicians more than the fair market value for their services in violation of the federal Anti-Kickback Statute.

The OIG has released the first of a series of audits regarding STAR+PLUS service coordination.

OIG regularly conducts audits to ensure providers are in compliance. This audit was performed to evaluate whether United Healthcare Community Plan complied with contractual requirements for performing service coordination in support of STAR+PLUS Level 1 members. 

OIG's Acute Care Surveillance Team has implemented a new record review process that saves providers time and money.

The process allows providers to submit medical records online. This will reduce paper record submissions and facilitate the process of record review, retention and sharing with other reviewers when appropriate. Providers still have the option to submit paper records.

The OIG's Benefits Program Integrity (BPI) unit completed 311 investigations in the third quarter where fraud was found.

The OIG is using a new tool to prevent fraud, waste and abuse.