Hammond gave examples of difficulties that their members were having with OIG investigations. One point she made was that there needs to be a differentiation made between fraud and an error. For mistakes as simple as forgetting to make sure the beneficiary’s name is on every page in the file, even though the service is delivered, OIG is demanding repayment for the service. The repayment can then be extrapolated for all such services rendered by the provider.
She also testified the Association has found that OIG is not applying Medicaid policy correctly in relation to providers although OIG could have been present when the policy was developed between HHSC and the Association.
Her testimony is on YouTube.