and the Hits Keep On Coming …. the Status of Texas HHSC and the OIG

As if the current investigations of the contract procurement programs at the Texas HHSC are not enough to occupy HHSC’s future plans, the Feds (FBI) have now been involved since January 15. Now it seems, the Feds were lied to by that procurement team or others involved in the 21CT contract procurement process. Jack Stick’s legacy and the OIG culture continue to be unwound. See http://www.texastribune.org/2015/02/10/did-hhsc-fudge-facts-get-18-million-feds/ and http://www.texastribune.org/2015/02/11/tribcast-expensive-chairs-new-badges-and-vaccines/. Mr Stick, it has been found, also had HHSC purchase executive office chairs (2) worth $2,800 each and badges (nearly 300) for his officers that cost nearly $300 each, badge holsters worth $16 each, and leather ID card holders worth $18 each. The chairs were nearly sent to Mr. Stick with his other office belongings, after his resignation. This opens up yet another chapter in the investigations under way in Texas, fully involving the Feds now. It may be that they (the contract investigations) are now out of the hands of Texas since self-investigation (Abbott’s strike force and Janek’s internal investigations?) is an obvious conflict of interest in HHSC. Furthermore, by having Stick, Wilson, and their respective wives and aide, stick around (excuse the pun) the office for another few weeks after their resignations, the internal HHSC electronic-paper trail may be in question. The so-called State fraud-detectors may have become the actual fraudsters in all of this. All of these investigations have enlightened calls for all of the State’s agencies to be scrutinized for their current contracting and spending processes. In the end, the 2013 Texas Legislature with Perry’s appointments may have created the unleashed and uncontrolled monster they earlier had called heroes in collecting from and finding so-called Medicaid fraudsters. Aside from the scandal here, the OIG software program may in reality have been in the red after real actuarial analysis.

The current relevant question from providers in Texas about HHSC is if these scandals are playing enough havoc with the operations in HHSC that everyday tasks are being delayed such as OIG open investigations of providers, payment hold cases, and even Medicaid (re)enrollment application processing. We have noticed delays in these application turnaround times by up to 2 months, making the current application process last more than 4 months. The OIG plays an active role in this process since they perform the appropriate physical visits of facility applicants and other background checks. Some of these application processes are skipping physical visits altogether in cases of provider clean record histories, even though they (HHSC-OIG visits) are required for (re)enrollment. This may now be at their subjective discretion.

HHSC has many current and important transitions to manage, including the transition from traditional Medicaid to 100% managed Medicaid by September 2016. Providers must then contract with all relevant regional MCOs for their client portfolio needs. The MCOs will then apply their own algorithms to populate their regional provider networks. This may include the pruning of their respective provider networks. Once this happens, a provider must show how their respective practices differentiate them from others in the area in order to keep or obtain new MCO contracts. Moreover, this process may take months. Hence, being prudent about signing up with your regional MCOs is as important as ever and well before the start of 2016, since last minute applications will surely be delayed shortly before the September 2016 deadline.