Provider Investigations reports first quarter results

January 27, 2022
The OIG’s Provider Investigations unit (PI) completed 451 preliminary investigations and 35 full-scale investigations in the first quarter of fiscal year 2022. PI investigates and reviews allegations of fraud, waste and abuse involving Medicaid providers.

Based on an investigation’s findings, OIG actions can include education, prepayment review of claims, penalties, required repayment of Medicaid overpayments and/or exclusion from the Medicaid program.

A sample of case results for Provider Investigations settled by Litigation for the first quarter includes:

The OIG settled a case in September against a Richardson dental provider. The dentist billed Medicaid for services not rendered by altering treatment charts and illegally solicited Medicaid clients by using gift cards. The provider agreed to pay $4,066 in overpayment and $8,133 in penalties to resolve this case.

The OIG settled a case in September against a Weslaco pediatric office. Over a four-year period, the provider was improperly submitting claims for molecular strep tests which were medically unnecessary and being billed with an incorrect date of service. The provider worked collaboratively with OIG Litigation to resolve these issues, and the OIG agreed to a settlement of $445,500

The OIG settled a case in October against a Dallas personal care attendant. The attendant was improperly submitting her time for services to her client during the investigation period of June 3, 2021 through June 6, 2021. The attendant was clocking in and out while her client was incarcerated, violating her employer’s internal employee policy. The attendant worked collaboratively with OIG Litigation to resolve the issue, and the client agreed to a penalty of $500.

Source: Provider Investigations reports first quarter results / Inspector General Texas Health and Human Services

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