A recent audit of the Texas Health and Human Services Commission’s Office of Inspector General turned up some concerning things. According to the audit, the OIG did very little to prevent Medicaid fraud.
OIG screening is designed to prevent the hiring of individuals who have committed fraud or other crimes that make them unfit to provide federal health care services. Unfortunately, the audit of the Texas OIG revealed that it took an average of over three years for the Texas office to close cases, and only a tiny percentage of fraudulent or erroneous payments were recovered.
According to the audit, the Texaz OIG identified $1.1 billion in Medicaid overpayments between 2012 and 2013, but only $5.5 million was recouped in that time period. This implies poor screening policies and possibly a misleading method of calculating violations, according the the American-Statesman. It could also mean that investigators failed to separate simple documentation mistakes from intentional fraud.
Though the OIG can freeze Medicaid payments to organizations and individuals on the OIG exclusion list for fraud or other crimes, the audit suggests that this authority was misused. Payment holds were used against providers who didn’t put Medicaid procedures at a significant financial risk, leading auditors to believe that the office was overzealous in their enforcement methods. In fact, the audit suggests that the OIG withheld government payment as leverage to encourage financial settlements.
“Considering the TX OIG’s position now, we can assume that more resources will be funneled into getting this process sped up so as to avoid further scrutiny,” says Jeff Josefovic, Director of Operations at Streamline Verify. “The fact that it took them 3+ years to close fraud cases, which, resulted in 100’s of millions of dollars being paid out for people whose services should have been excluded, almost guarantees a change. What this means for the healthcare industry is to stay on top of your monthly exclusion checks as soon as the lists are updated, which, will ensure that no one is slipping through the cracks.”
The audit was conducted by the Sunset Advisory Commission, which evaluates the performance of all state agencies in Texas. The audit concluded that errors on the part of the OIG had caused harm to taxpayers and medical providers alike.In light of the worrying audit results, the Houston Chronicle says that a special assistant will be appointed by the state’s top health official to review the existing program. If the audit results are confirmed, it’s possible that the state will have to share culpability for its part in the hundreds of millions of dollars lost because of medical provider fraud.