New providers seeking to participate in Texas Medicaid face months of delays in getting clearance from the Texas Health and Human Services Office of Inspector General, according to a source familiar with the applications. Apparently, some providers have been trying … Read More
We are republishing this article from the OIG website that was written for and published by Texas Dental Association (TDA). As the Texas Health and Human Services Office of Inspector General (OIG) works to prevent fraud, waste and abuse in … Read More
The Texas Health and Human Services Office of Inspector General (OIG) is under review by the Texas Sunset Advisory Commission this year, as a part of an overall evaluation of HHSC. OIG itself is inviting public input on its mission … Read More
Governor Greg Abbott reappointed Raymond Charles “Ray” Winter as the Inspector General for Health and Human Services for a term set to expire on February 1, 2026. Raymond Charles “Ray” Winter of Austin is the Inspector General for Health and … Read More
The latest OIG Quarterly report was released last month. It contains several important trends for dentists and trends in OIG investigations into dental practices. Firstly, OIG preliminary investigations into dentists and dental practices remain at their traditional level of 6%, … Read More
Yesterday, we received an OIG update that is valuable for Medicaid dentists. OIG has found concerns “about inappropriate administration of sedation and local anesthesia, discharging the patient before they fully recovered from anesthesia, and billing for sedation levels the provider … Read More
This week, Pro Publica and the Texas Tribune released the results of an investigation into the Texas Office of Attorney General Civil Medicaid Fraud unit and its recent tremendous loss of staff coinciding with the firing of its long-time head, … Read More
Inspector General Raymond Winter who came to post last October released his first quarterly report at the end of December. It is also the report for the first quarter of fiscal year 2024. No cases involving dentists highlighted OIG settled … Read More
The Office of the Inspector General just published a short interview with Inspector General Raymond C. Winter, who was appointed to the position last year. The interview is about his 2024 priorities. IG Winter had previously been a deputy attorney … Read More
Governor Greg Abbott announced yesterday that he has appointed Raymond C. Winter (“Ray”), former head of the Civil Medicaid Fraud division of the Office of the Attorney General, as the Inspector General for Texas HHS. He will replace Sylvia Hernandez-Kauffman, … Read More
OIG announced on their website yesterday that they were updating their self-reporting protocol for Medicaid providers. Here is what is said with a PDF copy of the protocol below. The OIG has updated the protocol providers use to voluntarily disclose … Read More
Last month, TDMR was told that Inspector General Sylvia Hernandez Kauffman was going to be leaving OIG sometime in September. Today, we received confirmation from an OIG spokesperson that Ms. Hernandez Kauffman will be leaving the position on October 2. … Read More
The Office of Inspector General has another proposed rule on the Texas HHS “Comment on Proposed and Draft Rules” webpage entitled – “Recoupment of Overpayments Identified by Retrospective Payment Review.” This one is another addition to the Texas Administrative Code … Read More
Last Friday, Texas Health and Human Services sent an email notification that OIG was proposing a new rule (bottom of page) concerning “recoupment of overpayments identified by inspection” and wants public feedback by August 11. Public feedback Public feedback? Well, … Read More
Last week, TDMR filed a complaint with the Texas Health and Human Services Office of Inspector General over the continuing complaints received by TDMR about the unacceptable delays in the credentialing of Medicaid dentists, particularly relating to the need to … Read More
The latest Texas HHS-OIG Quarterly Report issued last month, again for some reason, under provider integrity, focussed on findings made on investigations of Medicaid dental providers when these investigations only account for a tithe of full-scale investigations conducted by OIG. … Read More
Recently, an OIG audit of a managed care organization (MCO) found issues when determining the fair market value of outsourced services and behavioral health claims. The audit reviewed multiple financial statistical reports (FSR) for UnitedHealthcare Community Plan of Texas, L.L.C. including Medical … Read More
Texas Health and Human Services Office of the Inspector General came out with its last quarterly report for fiscal year 2022 this month. OIG provider settlements One of the key takeaways from the report is that 16% of the 147 … Read More
OIG recently published the following article on its website which we thought to republish here along with the PDF documents linked to in the article. Texas providers encouraged to self-report overpayments Providers continue to participate in the OIG’s self-report process, … Read More
Ensuring Texas Medicaid dollars are spent for their intended purpose requires the Texas Health and Human Services (HHS) Office of Inspector General (OIG) to work with health care professionals to prevent fraud, waste and abuse. Accurate medical and dental coding … Read More
The Texas Exclusions Database simplifies applicant screening for Medicaid providers, offering the ability to better protect their patients with real-time verification of potential employees before they are hired. Texas Health and Human Services (HHS) Office of Inspector General (OIG) protects … Read More
TDMR has learned that a number of Medicaid dentists around the state have been receiving informal letters from the Office of Inspector General about their billings. Avoid formal process Apparently, OIG is looking to resolve billing situations informally rather than … Read More
This was posted on the Texas HHS-OIG website yesterday. Thought we would republish.. ————————— Ensuring Texas Medicaid dollars are spent for their intended purpose requires the OIG to work with health care professionals to prevent fraud, waste and abuse. Accurate … Read More
The following article was supplied by Texas HHS-OIG. Keeping accurate and complete patient records is part of providing quality patient care. Good record keeping can also help protect a practice against allegations of wrongdoing. The patient record is a legal … Read More
The Department of Health and Human Services Office of Inspector General recently released its 2021 Medicaid Fraud Control Units (MFCU) Fiscal Year 2021 Annual Report. Investigates criminal fraud Medicaid Fraud Control Units have the job of investigating criminal fraud by … Read More
We found an article recently published on the OIG website that we thought should be republished here. Providers encouraged to self-report errors More providers are participating in the OIG self-audit process so they can determine if they need to self-disclose … Read More
The 2021 annual report published by Texas HHS-OIG on fraud and abuse recoveries by MCOs and DMOs again shows a minimal amount of Medicaid fraud being found and recovered considering the state’s whooping multi-billion dollar healthcare budget. For 2020/2021, the … Read More
It is remarkable that in a state that cherishes free enterprise, it is okay for dental maintenance organizations to offer money and other inducements to encourage parents with Medicaid-eligible children to use their company yet it is a crime for … Read More
On Tuesday, Texas HHS OIG sent out its June email newsletter. Out of the three articles promoted, one is again about dental Medicaid issues. This time the article is about common billing errors committed by Medicaid dentists, an article that … Read More
Almost a decade ago, on May 13, 2011, Byron Harris, famed WFAA investigative reporter, started a large freight train roaring down the track with his first story of a series, “Texas taxpayers pay big for straight teeth.” False narrative destroyed … Read More
This article is reprinted from the OIG Monthly Newsletter received today. The majority of Texas Medicaid dental providers take pride in their work and deliver excellent care to their patients. Those who try to cheat the system and fail to … Read More
Bill filing has started for the upcoming legislative session at the Texas Capitol. One of the early filings is HB 648, a bill introduced by House Rep. Richard Peña Raymond of Laredo to modify the mandate of the HHSC Office … Read More
Remember back in 2012 when the media and the state were outraged by dentists giving out gift cards or other small inducements to have Medicaid children get under care? In case you don’t, here are links to some media articles … Read More
Is it us or does Medicaid dentistry seem to get more attention in these reports than other specialties? Are we being sensitive? We couldn’t help but be struck by the fact that again complaints against Medicaid dentists make up only … Read More
