The Office of Inspector General published its first quarterly report for fiscal year 2020.

The OIG has a new web address to highlight its mission and connect with stakeholders.

ReportTexasFraud.com is the simple way to find the OIG online. The address emphasizes our work to ensure the integrity of Texas health and human services programs.

ReportTexasFraud.com redirects to our existing website, where you’ll continue to find updated information about the OIG’s work and results. Use the “Report Fraud” button at the top of the page to inform the OIG of suspected fraud, waste or abuse by a provider or recipient.

The Texas Medicaid Vendor Drug Program requests the OIG perform continuous audits of pharmacies enrolled in the program. If you are a Medicaid or CHIP provider and are notified to expect an audit by the OIG, here is the process you can expect.

Audit planning and fieldwork

A federal jury found a South Texas doctor guilty for a scheme in which he falsely diagnosed patients with lifelong diseases. The doctor from Mission was convicted in January of numerous counts including health care fraud. The case was investigated by The Rio Grande Valley Health Care Fraud Task Force, which includes the OIG, FBI and Texas Medicaid Fraud Control Unit. The U.S. Department of Justice prosecuted the case in front of a federal judge.

The OIG conducted an audit of CMC Health Plan (CMC), a Texas Medicaid managed care provider, to assess its effectiveness in storing confidential HHS information. CMC provides Medicaid managed care to its members through the STAR Kids program.

CMC is required to protect and secure confidential HHS system information, such as claims data. The OIG conducted this audit to assess the design and effectiveness, during state fiscal years 2018 and 2019, of selected security controls over confidential HHS information.

Our Medicaid Program Integrity (MPI) team recovered more than $17 million in the first quarter of fiscal year 2020. This division investigates and reviews fraud, waste and abuse allegations against providers; reviews hospital and nursing facility claims and medical records; and screens providers seeking to enroll in Medicaid.