This afternoon, the Health and Human Services Commission Inspector General Stuart Bowen sent out his second quarterly report – quite unlike his predecessor who sent out no such reports. It is a remarkable 28-pages and will take some time to digest. However, we wanted to get this out as quickly as possible before commenting.
Here is Bowen’s initial message from the report:
I am pleased to submit to Governor Abbott, Executive Commissioner Traylor, the Members of the Texas Legislature, and the Citizens of Texas my Office’s second Quarterly Report, capturing the work my team and I accomplished since September 1. This report reveals a story of steady progress toward achieving the vision I set for our agency 40 weeks ago when I began my appointment: to be the best Inspector General operation in the country. “To be the best,” I told my staff at our agency-wide meeting last week, “we must succeed in hitting our metrics and accomplishing excellent work
This report reveals a story of steady progress toward achieving the vision I set for our agency 40 weeks ago when I began my appointment: to be the best Inspector General operation in the country. “To be the best,” I told my staff at our agency-wide meeting last week, “we must succeed in hitting our metrics and accomplishing excellent work while firmly adhering to our values.” The quarter saw key progress in all aspects of our mission fulfillment, as my highly capable and motivated IG team continued to coalesce around our core values: professionalism, productivity, and perseverance.
Section One of this report provides a concise overview of our agency’s activities, starting with how we executed our commitment to collaborate closely with HHSC leadership, as the Health and Human Services System moved into major consolidation mode. Notably, the section highlights Executive Commissioner Traylor’s auspicious provision of 18 inspectors for our new Inspections and Evaluations Division. Please read the excellent interview with him in Section One; it substantiates the collaborative spirit that has developed between the IG and HHSC over the past 40 weeks. The section also lays out this quarter’s wide-ranging mission progress, including our extensive stakeholder outreach engagements, our innovative reform and restructuring agenda, and the establishment of a Data and Technology Division to provide order and expertise to this mission-critical area.
Section Two presents our first Program Insight report, reviewing Medicaid, the largest service delivery component within the System. The section includes a fascinating interview with Gary Jessee, the new State Medicaid Director. Sections Three through Five outline the important progress my Investigations, Audit, and Inspections Divisions achieved during the quarter.
I thank my outstanding IG Team for courage, constancy, and commitment demonstrated consistently throughout 2015, a year of extraordinary change. I look forward to working with all of them in 2016, as we strive to realize our vision, live our values, and fulfill our mission.
Stuart W. Bowen, Jr.
Here are some statistics provided with this message:
Dollars recovered
Litigation
Overpayments and penalties $1,122,799
Investigations
Research Analysis and Detection reviews $796,567
General Investigations collections $4,253,075
Audit
Hospital Utilization Review $4,851,472
Nursing Facility Utilization Review $1,660,598
Total $12,684,511
Dollars identified for recovery
Investigations
RAD identified MCO overpayments $168,410
SIU identified MCO overpayments $2,845,747
LED overpayments identified $18,966
GI claims in recovery $8,566,198
Audit
Provider overpayments $527,006
Hospital outpatient costs reports $239,000
Inspections and Evaluations
WIC vendor monitoring $33,720
Total $12,399,047
Dollars identified as cost avoidance
Litigation
Providers ordered to pay restitution $2,027,525
General Investigations
GI disqualifications $898,500
Income eligibility matches $2,374
Other data matches $645,568
Audit
Pharmacy Lock-In $51,831
Total $3,625,798
The full report can be downloaded here.