An OIG fraud detection operation (FDO) uncovered potential illegal dental solicitation among Medicaid providers.

The OIG has released the next audit in its series looking into service coordination for STAR+PLUS Level 1 members.

The objective of this audit was to evaluate whether HealthSpring Life and Health Insurance Co., Inc., doing business as Cigna-HealthSpring (Cigna), a Medicaid and Children’s Health Insurance Program (CHIP) managed care organization, complied with contractual requirements for performing service coordination.

The OIG’s Benefits Program Integrity Division resolved a case in which a client repeatedly failed to report an income-earning family member.

The OIG conducted an audit of MCNA Insurance Company, a Texas Medicaid and CHIP Dental Maintenance Organization (DMO).

The audit objective was to evaluate the effectiveness of MCNA Texas performance in complying with selected contract requirements, achieving related contract outcomes, and reporting financial and performance results to HHSC. The audit scope included MCNA Texas policies, practices, and activities related to claims processing and financial and performance reporting.

In fiscal year 2019, the OIG developed a fraud, waste and abuse (FWA) prevention strategy focused on raising awareness of FWA and educating three audiences: Medicaid providers, Medicaid clients, and HHS staff.

The OIG engaged providers by publishing articles in medical association publications and posting a fraud and abuse prevention advisory on the OIG website. Staff leveraged social media channels to warn patients to be wary of marketers who offer cash, gifts or other items to influence their health care decisions.

The OIG has taken an increasingly data-driven approach to fighting wrongdoing in Medicaid delivery. Using data analytics helps us increase the detection of fraud, waste, and abuse by assessing billing trends and patterns of providers, clients and retailers participating in HHS programs.

Experienced staff at the OIG have developed algorithms and data analysis processes to pinpoint areas where fraud may be occurring. After focusing attention on a particular provider or geographic region, the OIG then can deploy investigators and experts to corroborate findings from the data.