Inspector General Winter’s First Quarterly Report

Inspector General Raymond Winter who came to post last October released his first quarterly report at the end of December. It is also the report for the first quarter of fiscal year 2024.

No cases involving dentists highlighted

OIG settled multiple cases involving healthcare providers. No cases involving dentists were mentioned, which is a pleasant surprise.


In one case, a medical supply provider failed to maintain adequate records, resulting in a settlement of $14,199. Another case involved a home health provider who employed a prohibited person and improperly submitted claims, resulting in a settlement of $35,136. The OIG also settled cases with a laboratory company and a hospital that billed for unallowable codes, resulting in settlements of $799,226 and $720,723, respectively. Pediatric practices that double-billed for hearing tests were settled for a total of $445,542. Other settled cases involved a hospice provider, a pharmacy billing for drugs not purchased, a cardiovascular specialist, and an out-of-state laboratory provider. The OIG also provided statistics on preliminary investigations, provider enrollment and exclusions, and recoveries in the acute care and hospital/nursing home sectors.

The OIG’s Medicaid Program Integrity (MPI) team conducted fraud detection operations focused on prescription services billed to Texas Medicaid at a higher rate.

The OIG’s Fraud Analytics team developed a predictive model using artificial intelligence to identify potential fraud.

Baylor Scott & White Health (BSW) provided behavioral health services to its patients via teleservices. However, an audit found that BSW double billed for behavioral health teleservices, billed unallowed facility fees, and incorrectly billed for psychotherapy services. As a result, BSW was overpaid and should repay $45,413 to the state of Texas. Additionally, BSW failed to provide required privacy practice notifications to some patients.

An East Texas barbecue restaurant was found purchasing SNAP benefits from recipients and using them illegally at various retail stores for restaurant supplies. The investigation uncovered $12,694 in fraudulent charges using 16 EBT cards and an additional $2,654 in fraudulent charges using one card. The restaurant owner and benefit recipients admitted to the scheme. The case has been referred to the district attorney’s office for prosecution.

In another case, a food truck owner was caught using SNAP benefits for inventory purchases. The investigation revealed that five EBT cards not belonging to the owner were used on his account, resulting in $10,265 in fraudulent charges.

Stakeholder meetings were held with the Texas Fraud Prevention Partnership (TFPP) and other organizations.

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