Texas State Medicaid Fraud Control Unit: 2013 Onsite Review

WHY WE DID THIS STUDY

OIG oversees the activities of all Medicaid Fraud Control Units (MFCUs or Units). As part of this oversight, OIG conducts periodic reviews of all Units and prepares public reports based on these reviews. The reviews assess Unit performance in accordance with the 12 MFCU performance standards and monitor Unit compliance with Federal grant requirements.

HOW WE DID THIS STUDY

We based our review on an analysis of data from seven sources: (1) a review of policies, procedures, and documentation of the Unit's operations, staffing, and caseload; (2) a review of financial documentation; (3) structured interviews with key stakeholders; (4) a survey of Unit staff; (5) structured interviews with the Unit Director and supervisors; (6) an onsite review of case files; and (7) an onsite review of Unit operations conducted in August 2013.

WHAT WE FOUND

For fiscal years (FYs) 2010 through 2012, the Texas Unit reported recoveries of over $844 million, 339 criminal convictions, and 48 civil judgments and settlements. Our review found no evidence of significant noncompliance with applicable laws, regulations, or policy transmittals. However, we found that the Unit did not transmit all conviction information to OIG in a timely manner.

WHAT WE RECOMMEND

We recommend that the Texas Unit ensure that it transmits information about all convictions to OIG for exclusion within 30 days of sentencing. The Unit concurred with our recommendation.

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