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The committee met to hear testimony from Acting Deputy Inspector General Quinton Arnold, Office of the Inspector General (OIG). 

Chairman Richard Raymond comments:

  • Taxpayer dollar expenditures should follow the law, serious issue for State
  • State has been “defrauded” of “hundreds of millions” of dollars
  • Essentially defrauding the taxpayers of Texas

 
Sunset Recommendations for the OIG and OIG status
Quinton Arnold, Deputy Inspector General

  • Internal OIG review is ongoing, expect summary report by March 2
  • OIG mission: fraud, waste, and abuse
  • Compliance, Enforcement, Chief Counsel, Internal Affairs, Operations
  • Rep. Elliot Naishtat asks if Arnold is going to serve as deputy IG in the future
    • On temporary assignment for up to 6 months, 4 and one half remaing
  • Naishtat comments that Enforcement has highest proportion of unfilled positions and asks if this is surprising information and is it concerning
    • Concerned about every unfilled position as all are important to OIG mission
    • Legislature approved large number of positions, many in enforcement, last session and some remain unfilled
    • More important than sheer numbers are the vacancies of key positions, Deputy IG for Enforcements and Director of Medicaid Provider Integrity Unit vacancies given as examples
  • Compliance division performs risk-based GAO complaint audits and reviews providers, vendors, and contractors to ensure compliance with regulations and laws
  • Determine high-risk providers via risk-assessment and hotline
  • Sunset recommendation was to consolidate OIG Compliance and HHSC cost report functions, affects roughly 55 personnel
  • Rep. Susan King asks what the criteria for using the Compliance hotline
    • Compliance receives calls ranging from anonymous tips to disclosure of significant amount of information
    • Ability to investigate hinges on how much information is received from hotline calls
  • King asks if OIG has an idea of how many investigations result from the hotline and how many of these are anonymous
    • Arnold responds that this can be found
  • Enforcement division investigates provider fraud, waste, and abuse (relating to MPI, SNAP, TANF, CHIP, WIC)
  • Establishing monthly requirement for managers to
  • Looks to review trends quarterly
  • Goal is to share information regularly
  • Focused on improving employee training
  • Developing training plans and modules focused on basic research skills, chip provided 8 hour informational course and general investigations unit partnered to provide 80 course, both incorporated into training modules
  • Developing mobile training team to service desperate offices
  • Critical issue is case backlog, 433 cases still backlog cases. Planning to complete by December 31, 2015
  • Establishing process for determining viability of cases, 78 cases closed for insufficient evidence, many other minor funds cases referred to research unit, very successful
  • Establishing procedures for consultant review of casework to improve efficiency
  • Chief counsel division: legal and sanctions
  • Sanctions works to recover funds, legal oversees case and policy development
  • Raymond asks over what period of time cases have been dismissed
    • Very recently, past 5 or 6 months
  • Raymond comments that OIG is an agency that instead of doing what State asked them to do, they were looking at clerical errors and viewing them as cases of fraud, asks Arnold to talk about Brad Nelson
    • Arnold brought Joyce Barkes, Chief Counsel, to help answer this issue
    • MPI would look at provider files for errors, usually in a small subset of a provider’s total files, and extrapolate those errors to apply to the provider’s entire case history
  • Raymond comments that Nelson was one of those who made the determination of how to apply found errors to a provider’s case
    • Nelson’s actuarial work was meshed with consultant opinion and run through algorithms to determine provider error tendency and outlook
    • Nelson was responsible for all the work pertaining to certain providers and did some “things that were not right” and was not accurate in assessing claims against providers
  • Raymond comments that the committee only discovered Nelson after  doctor investigated by the OIG raised questions over his firing
  • Raymond was only able to find out what cases Nelson worked on after signing a confidentiality agreement with OIG, comments that this should be unlimited public information and transparent
    • Arnold concurs with Sunset Recommendation that OIG should be forthcoming about providers affected by situations such as inaccurate actuarial work
  • King asks what the negative impact on providers was due to these false accusations, and are they still willing to work with HHSC
    • This is a complex question, could talk at length about this one issue
  • Raymond asks if Arnold thinks that what is happening at OIG has impacted doctors not wanting to participate in Medicaid
    • Yes, as Sunset outlined this is a very important issue
    • OIG has a number of ideas to investigate providers and reduce harm to relations
  • Dr. Spitzer comments that OIG should keep the focus on patients, also should not fatigue providers with clerical errors, but rather look at big problems and the larger picture of fraud
  • Rep. Toni Rose concurs, cautions that the ones most affected by fraud and improper investigations are the most vulnerable, i.e. patients
  • Internal Affairs division: Forensics Research and Analysis Unit (Data), Investigations Unit, State Center Investigative Team (Abuse and neglect of state-supported individuals), Vital Statistics Administrations Unit
  • Significant Sunset Recommendation for IA to re-examine employee misconduct, Deputy of IA is developing process to properly investigate and is preparing for meeting with HHSC over this issue
  • IA will not investigate all deaths, rather focus on those affecting State facilities and programs
  • OIG is developing an MOU with Judge Specia of DFPS that outlines the types of things IA will look at concerning deaths
  • Recommends that an organization external to DFPS provide oversight over DFPS investigations
  • Rep. Four Price comments that Sunset noted inadequate training within OIG regarding functions and programs it is auditing or investigating, asks what is happening to address this
    • Great concern of OIG as well, predominantly an issue with the Enforcement division
    • Need to extend training program across all divisions of OIG
    • Refers to training programs mentioned earlier on CHIP and Medicaid
    • Also looking at how often an issue needs to be retrained
  • Prevention should be a top priority of OIG, more efficient than pursuing matters after infractions have occurred
  • Each division plays a part in prevention, can be more structured
  • Four asks if there is anything within Sunset that Arnold disagrees with
    • Did not disagree significantly, most of the recommendations drive OIG to develop policies and procedures OIG should be doing regardless
    • Many Sunset recommendations were discussed in drafty policies internally by the OIG
  • Operations division: Business operations (Internal data), Center for Policy and Outreach (Training, Provider Resources), Managed Care Unit (MCO), Technology Analysis, Development, and Support (Ensure Medicaid is payer of last resort)
  • OIG has been asked to be more transparent with provider criteria and information
  • Website is a priority for OIG and OIG recognizes it as the best means of communicating with providers, Bowen is a huge proponent
  • Raymond comments that Sunset Recommendations will be contained in Sunset bills
  • Raymond asks Arnold to tell them why Doug Wilson, IG and Jack Stick, Deputy IG Enforcements, had to resign
    • Jack Stick resigned over the contract issue currently under investigation
    • Doug Wilson resigned due to Governor’s request over the Sunset issues, perception of the OIG, and the contract issue
    • Criminal investigation currently ongoing
  • Raymond asks for a summary on the contract issues
    • Contract that OIG had with 21CT to provide technology for pursuit of fraud, waste, and abuse
    • 19.8 million dollars, originally 20 million and was scheduled to be extended to 90 million
  • King asks why WIC is listed as a monitored program and not SNAP
    • GI does look at SNAP program, uncertain if OIG audits SNAP
    • Quality Review section of Compliance looks at WIC
  • King comments that she and Raymond would like to look at SNAP
  • King asks if DFPS and OIG both look at abuse and neglect of state-supported individuals
    • Internal affairs does look at this
    • DFPS has an internal office, OIG has purview over these investigations, OIG IA looks at employees at state-supported living centers
    • Potential for overlap, MOU intention is to delineate those investigations