Reform sought for agency investigating health, human services fraud – Caller-Times

AUSTIN — Texas is looking to reform the state office that goes after fraud in health care and human services: the Office of Inspector General.

The Sunset Advisory Commission, which targets government waste within state agencies, recommended changes to the office this month. The office has been accused of witch hunting and trivially withholding Medicaid payments to the detriment of health care providers in Texas.

"We can no longer have an OIG that accuses providers of fraud, presumes them guilty, and denies them due process," state Sen. Juan "Chuy" Hinojosa, D-McAllen, said in a statement applauding the recommendations. "The Legislature envisions an OIG that targets the health care providers who are defrauding our taxpayers and not those who commit clerical errors. The recommendations adopted today will work to alleviate these concerns by providing due process, increasing transparency, and getting at actual fraud while not wasting our resources on innocent providers."

Hinojosa headed a work group that considered changes to the office.

The work group’s changes included clarifying the definition of fraud so that it doesn’t encompass unintentional technical, clerical or administrative errors. The work group also recommended streamlining the office’s processes.

Hinojosa said in an earlier hearing that the process of an investigation can take years, significantly affecting the reputation of a health care provider that has an ongoing investigation for so long.

The recommended changes would also make the office more transparent, as they would require the office to give detailed summaries of all evidence in fraud allegations, provide a next-steps timeline and explain the provider’s rights.

The recommendations came soon after a state appeals court said the office’s tactic of withholding Medicaid payments while investigating was illegal.

via Reform sought for agency investigating health, human services fraud – Caller-Times.

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