UPDATE: “Cooked Books” Caused OIG to Settle for $39,000 in $16 Million Dental Medicaid Case

THHSC building
Texas Health and Human Services Commission

A Texas Health and Human Services Commission employee in the Office of the Inspector General was fired because he apparently “cooked the books” in OIG’s case against Dr. Rachel Trueblood, according to a story published in the Austin American Statesman yesterday evening.

UPDATE: HHSC termination letter to Brad Nelson, former senior actuary download

Settlement offer sent one business day after firing

The Statesman’s investigation found that the employee was fired and escorted out of OIG offices one business day before a $39,000 settlement agreement in the Trueblood case was sent to her lawyer Jason Ray.  OIG was initially seeking some $16 million from Trueblood.

Agency misled the public on reason for lowball settlement

Originally, the agency had said they lowballed the settlement because Trueblood was near bankruptcy.  Stephanie Goodman, spokesperson for HHSC, said the agency “can’t get blood from a turnip.”

Employee admitted to falsifying data in case

However, the employee, Brad Nelson, a senior actuary, apparently admitted falsifying data in the case to the agency.  His admission now throws into doubt another 18 cases on which he worked and should influence the usual multi-million dollar amounts demanded by OIG in such cases.

Needless to say, OIG has not informed any of the individuals involved in these cases per the article.

Throws into doubt OIG demands in other cases

As the Statesman points out, “the actuarial work … lays the statistical foundation for the investigations by determining which patient files were selected for review, and whether that selection was valid — building blocks necessary to calculate error rates and restitution.”

The four-page termination letter to the employee, quoted in part in the article, states:

“Your behavior in falsifying sample data, and lying to co-workers and supervisors was deceitful, unethical and violated HHS policy…It also jeopardized this (Trueblood) case and potentially others, which could result in a loss of millions of dollars in restitution from providers.”

All OIG cases should be called into question and reviewed

Considering the recent damning report from the staff of the Sunset Commission on the lack of professionalism and disorganization of the Office of the Inspector General, the result of any OIG investigation should be immediately called into question and reviewed by a neutral third party agency.

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