This OIG review is an assessment of the Texas Health and Human Services Commission's Medicaid capitation rate setting process. Issued May 23, 2019.

Issue Brief: Encounter Data

January 2019 Issue Briefs

This Issue Brief outlines how the OIG uses encounter data (a record of paid cliams by MCOs and DMOs) to monitor and detect fraud, waste, and abuse. Issued January 17, 2019.

Data Review: Medicaid Lock-In Program

October 2018 Issue Briefs

This data review provides an overview of the Medicaid Lock-In Program, which is used to restrict the overuse of medical services.

This issue brief provides an overview of attendant care services, which provide Medicaid clients the assistance they need to stay in their community, instead of living in a long-term care (LTC) facility.

Issue Brief: Value-Based Payments

October 2017 Issue Briefs

This issue brief provides an overview of value-based payments, which are structured to incentivize providers to delivery quality care in the most cost-effective manner.

Issue Brief: Recovery of Funds

September 2017 Issue Briefs

This issue brief provides an overview of new state and federal guidelines for Medicaid managed care organizations about the recovery of improper payments and how other states distribute recovered Medicaid funds.