Medicaid anti-fraud program garners more scrutiny – San Antonio Express-News

AUSTIN – The top health official in Texas has decided to appoint a special assistant to review the state’s Medicaid anti-fraud program after an audit found it is so poorly run that it may be better for taxpayers if it did not exist.

The audit found the Texas Health and Human Services Commission’s Office of Inspector General conducts virtually no prevention efforts, takes an average of more than three years to resolve cases of alleged fraud, abuse or waste and wins back only a fraction of the amount of inappropriate spending it finds.

In fiscal years 2012 and 2013, according to the audit, OIG investigators identified more than $1.1 billion potentially over-billed by Medicaid providers, but collected just $5.5 million.

Moreover, auditors said the program’s overzealous use of federal law allowing it to freeze Medicaid payments of suspected fraudsters has forced some providers out of business.

Executive Commissioner Kyle Janek said he hopes to have his special assistant in place by Nov. 1 to start working to “make sure policies and processes are fair and effective and clearly communicated to providers,” spokeswoman Stephanie Goodman said.

Medicaid anti-fraud program garners more scrutiny – San Antonio Express-News.

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