|
Referral Source |
Received |
|
Office of the Attorney General’s Medicaid Fraud Control Unit (MFCU) |
9 |
|
Board of Medical Examiners |
7 |
|
Board of Licensed Vocational Nurse Examiners |
80 |
|
Board of Nurse Examiners |
154 |
|
Health and Human Services/Office Inspector General |
15 |
|
Health and Human Service Commission, Office of Investigations & Enforcement, Medicaid Program Integrity |
65 |
|
Pharmacy Board |
2 |
|
Surveillance & Utilization Review System (SURS) |
49 |
|
Texas Department of Health (TDH) |
1 |
|
Provider |
1 |
|
Total Cases Opened in 4th Qtr. 2000 |
383 |
|
Cases Opened and Closed during the 4th Qtr 2000 |
(211) |
|
Remaining Open Cases in 1st Qtr. 2000 |
201 |
|
Remaining Open Cases in 2nd Qtr. 2000 |
135 |
|
Remaining Open Cases in 3rd Qtr. 2000 |
121 |
|
*Remaining Open Cases in FY99 |
*581 |
|
*Remaining Open Cases in FY 98 |
*263 |
|
*Remaining Open Cases Prior to FY97 |
*210 |
|
Total cases opened |
1683 |
* Many of these cases are in Sanction status and will not be closed until the Sanction is completed.
|
Status Code |
Definition of Status Code |
Total Number |
|
1 |
Preliminary Investigation |
427 |
|
2 |
Full Scale Investigation |
417 |
|
Total |
844 |
|
Status Code |
Referred To |
Total Number |
|
3a |
Office of the Attorney General’s |
|
|
3a1 |
Office of the Attorney General’s |
|
|
3c |
Office of the Attorney General’s |
|
|
3f |
Utilization Review Division |
1 |
|
3i01 |
State Board of Dental Examiners |
8 |
|
3i03 |
State Board of Pharmacy |
1 |
|
3i07 |
State Board of Medical Examiners |
1 |
|
3i09 |
State Board of Certified Nurse Aides |
1 |
|
3j |
HHSC Nurse Review |
3 |
|
3m01 |
NHIC Education Visit |
33 |
|
3m04 |
NHIC for Application Surveillance |
1 |
|
3r |
Health Facility Compliance |
1 |
|
3t |
Health & Human Services’ Office of Inspector General |
2 |
|
3w |
Medicaid Part A & B |
1 |
|
4 |
Pending Sanctions |
72 |
|
4b |
Pending Appeals |
6 |
|
Total |
221 |
|
Status Code |
Sanctions Imposed |
Total Number |
|
5a |
Recoupment |
410 |
|
5b |
Vendor Hold |
81 |
|
5f |
Request for Reinstatement |
3 |
|
5g |
Global Settlement |
2 |
|
5e |
Pending Exclusion |
122 |
|
Total |
618 |
|
|
Total Number of Open Cases |
1683 |
|
Office of Investigation & Enforcement Area |
Total |
|
Compliance Monitoring and Referral |
$2,319,174 |
|
*Medicaid Fraud & Abuse Detection System -- Dollars identified |
$2,154,817* |
|
Medicaid Fraud & Abuse Detection System -- Dollars recovered |
$1,114,159 |
|
Utilization Review – Case Mix (Nursing Homes) |
$2,070,686 |
|
Utilization Review – DRG (Hospitals) |
$7,463,139 |
|
Utilization Review – Tax Equity & Fiscal Responsibility Act (TEFRA) |
$15,372 |
|
Surveillance and Utilization Review Subsystems -- SURS |
$373,802 |
|
Medicaid Program Integrity |
$856,084 |
|
Medicaid Program Integrity – Civil Monetary Penalties |
$48,897 |
|
TOTAL |
$16,416,130 |
* This amount represents claims inappropriately paid based on policy and/or investigations. It does not represent the actual dollars that may be recoverable.
Note: Total recoupment dollars reflect all active cases within OIE. Investigations refer only to active, full, fraud and abuse investigations.