The OIG conducted an audit of a Texas Medicaid and CHIP Dental Maintenance Organization (DMO). The audit evaluated the DMO’s effectiveness in complying with selected contract requirements, achieving related contract outcomes, and reporting financial and performance results to Texas Health and Human Services (HHS).

The audit found that the DMO allocated $273,926 in indirect sales and marketing expenses that were unallowable because the expenses were associated with activities outside Texas and unrelated to Texas Medicaid and CHIP. Other unallowable corporate expenses include:

The Office of Inspector General (OIG) understands that during the COVID-19 pandemic providers may experience increased demand for services and staffing shortages. The rapidly evolving situation may make it difficult to meet deadlines and place a strain on providers as they care for Texans. In order to assist health care professionals as they care for patients, the OIG is extending a variety of deadlines for providers involved in an audit, investigation, inspection or medical review.

COVID-19 agency news

March 17, 2020

On March 13, Texas Governor Greg Abbott declared a state of disaster in Texas due to the new coronavirus disease 2019 (COVID‑19). The OIG continues to maintain operations during this time.

The public can continue to contact the OIG through the OIG fraud hotline: 1-800-436-6184 or our main number: 512-491-2000. The OIG website and social media channels will continue to provide updated information.

Our fraud hotline answered 6,931 calls in the first quarter of fiscal year 2020. A total of 7,449 calls were received, which is an answer rate of 93 percent.  The average wait time for callers was 18 seconds. Once answered, calls averaged 6 minutes and 7 seconds to complete.

The OIG’s Electronic Benefits Transfer (EBT) unit completed 67 investigations and presented another 31 investigations for either administrative disqualification hearings (14) or prosecution (17).

Governor Greg Abbott has reappointed Sylvia Hernandez Kauffman as the Inspector General for Health and Human Services for a term set to expire on February 1, 2021.