OIG Video Flawed on Educating Medicaid Providers on Due Process Rights

This past Wednesday, the same day as the House Committee on Human Services hearing on SB 1803, HHSC sent out a notice that it had placed online a video for Medicaid providers about Office of the Inspector General investigations. This video was a requirement for OIG to produce under the SB 1803 legislation to inform and educate Medicaid providers about the OIG investigation process for fraud, waste and abuse and provider due process rights. The six-minute video apparently took a year to produce and get online. It so far has 300 views and the number of Medicaid providers in Texas is in the tens of thousands.

Does not make clear that option to a formal hearing could be lost

The video is flawed in that it did not make clear that if a provider requests an informal resolution meeting on a payment hold within the 30 day time frame to do so, if they do not within that same 30 day period also request a formal hearing at SOAH, they will lose the right to that formal hearing. This point is not specifically mentioned in the video which merely describes the informal resolution process and then states that if provider wants a formal SOAH hearing they have to request it within 30 days of receiving the payment hold notice. A provider can easily miss the import of this.

Can be confusing for a provider

It is quite reasonable for a provider to assume that after the informal hearing process, they could then request a formal hearing. But this is not the case under SB 1803. That request must occur within 30 days of receiving the notice of the payment hold regardless if they want to have informal resolution meetings or not.

As the first informal meeting takes place more than 60 days after their request, unless they have informed legal counsel, they will not find out their mistake until too late.

While the video was fine in other details, this point should have been highlighted.

It is on Youtube and below.

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