The Health and Human Services Commission Office of Inspector General investigates waste, abuse and fraud in all health and human services programs in the State of Texas.

Waste, abuse and fraud may fall into one or more categories. Examples of waste, abuse and fraud include, but are not limited to:

• Third Party Resources involves suspicion or evidence that a third party (e.g., employer health insurance, auto insurance, worker's compensation, etc.) is liable for costs incurred by Medicaid.
• Provider waste, abuse and fraud includes:
  • Medicaid Provider Integrity (Provider Investigations) involves waste, abuse and fraud in the Medicaid or Children's Health Insurance Program (CHIP), including billing for services not provided or not medically necessary.
  • Audit (Contractor and Vendor) reviews contracts and grants for potential waste, abuse or fraud (e.g., services not provided, unallowable expenditures, etc.)
  • WIC (Contactors/Local Agency) & WIC (Grocers/Vendors) should be referred if there is suspicion of waste, abuse and fraud related to their participation or administration of the Women, Infants and Children (WIC) program.
• Recipient waste, abuse and fraud includes:
  • General Investigations involves suspicion of waste, abuse and fraud in food stamps, Medicaid and TANF-cash assistance programs, (e.g., knowingly misstating or concealing information in order to receive more benefits.)
  • Limited Program includes abuse and overuse of Medicaid health benefits.
  • WIC Investigations occur when false reporting of income, household number, residency and/or abuse and trafficking of benefits is suspected.
• Internal Affairs involves investigations of employees, contractors or vendors including suspected cases of:
  • Abuse, neglect and exploitation at Texas Youth Camps
  • Retaliation against employees under the Whistleblower Act; and/or
  • Fraud or abuse involving vital records with the Bureau of Vital Statistics