Janek to Hire Special Assistant to Reform HHSC-OIG

HHSC Executive Commissioner Kyle Janek
HHSC Executive Commissioner Kyle Janek

The Houston Chronicle has reported that as a result of the Sunset Commission’s scathing report on the Health and Human Services Commission Office of Inspector General, HHSC Executive Commissioner Kyle Janek is appointing a special assistant to review OIG procedures and policies. The special assistant is to be in place by November 1.

Senator Jane Nelson told the paper, “The problems identified in this report are unacceptable and need to be addressed. We will get to the bottom of this issue, but we have a lot more digging to do.”

Payment holds hurting providers unfairly

The article points up the problems Medicaid dental providers under OIG investigations have faced, particularly on the subject of payment holds based on “credible allegations of fraud.”

On the issue of payment holds, the audit found state officials were wrongly using the move as a “bargaining chip” to get alleged fraudsters to settle their cases.

It also found the process can be overly lengthy and expensive, forcing providers out of business at a time when the state needs all the Medicaid providers it can get.

OIG not covering its own costs

The ineffectiveness and costliness of OIG operations were also highlighted.

While the agency with a $61 million annual budget technically recovered $273 million in fiscal year 2013, almost all of it were “third-party” collections gathered on behalf of other agencies.

“Minus third-party liability figures, OIG’s cost-recovery efforts struggle to recover OIG’s costs,” according to the audit, adding that “begs the question of what the state gets, or could get, in return.”

“It’s spot on.”

Lawyer Tony Canales who represents many Medicaid dentists said:  “It’s spot on.  The system is abusive. There are no checks and balances. And maybe now they’ll do something about it.”

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