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SB 1803 directs OIG to adopt rules establishing the criteria for initiating a full-scale fraud or abuse investigation, conducting the investigation, collecting evidence, and establishing minimum training requirements for Medicaid fraud or abuse investigators. To monitor the enforcement of protec-


tions provided by SB 1803 and to recom- mend additional changes in the law, the House Committee on Public Health, the House Committee on Human Services, and the Senate Committee on Health and Human Services will periodically review information from HHSC and OIG. “The most common complaint I heard


from stakeholders was that they felt OIG was operating ‘in the dark’ and that pro- viders did not know what to expect if they were accused of fraud or an over- payment,” Senator Huffman said. Dr. Holcomb says all these changes


are steps in the right direction, adding that the involvement of knowledgeable


medical and dental directors who can lend clinical perspective in the adjudica- tion process is encouraging. Michelle Romero, TMA associate


director for advocacy, says the bill rep- resents some improvements over the original rules but doesn’t go far enough to protect physicians. Through rulemak- ing, she says, TMA will work with OIG in an effort to lend more transparency to OIG’s investigation process and to afford physicians greater due process.


Focus on Medicaid fraud Investigating and preventing fraud, waste, and abuse in the Texas Medicaid program received considerable attention this legislative session. Senator Huffman says that has to do with OIG’s role in recovering erroneous, fraudulent, and wasteful payments in the state’s health and human services programs to the tune of billions of dollars. SB 1803 wasn’t the only bill related


to OIG operations filed this session. Sen- ate Bill 8 by Sen. Jane Nelson (R-Flower Mound) and Representative Kolkhorst takes effect Sept. 1. The bill validates the authority of the inspector general to detect and investigate fraud at all levels of the state health and human services system. It also creates a data analysis unit within HHSC and authorizes OIG to employ and commission peace officers to assist the office in carrying out fraud investigations.


Senator Nelson says the legislation


will allow the state to take a proactive approach to identifying potential fraud in the Medicaid program. “SB 8 directs HHSC to develop a pro- gram to identify outliers, anomalies, and red flags in the Medicaid program so that we can deal with abuse trends on the front end. This will not only prevent lost revenue but also make the investiga- tion process work more efficiently for all parties,” she said.


Appeals court backs TMA on workplace breastfeeding


The Fifth Circuit U.S. Court of Appeals agrees with the Texas Medical Asso- ciation and the Texas Pediatric Society (TPS) that a Houston federal judge wrongfully ruled against a woman who says her employer fired her because she wanted to pump breast milk. The court said “discriminating against a woman who is lactating or expressing breast milk” violates federal law. It overturned the decision and sent the case back to the trial court for further proceedings. TMA and TPS said in a brief to the appeals court that U.S. District Judge Lynn Hughes erred when he ruled that childbirth ends pregnancy-related medi- cal conditions and that Title VII of fed- eral law does not protect women from being discriminated against or fired for lactation and breast pumping. TMA and TPS filed the brief to sup- port an appeal by the U.S. Equal Employ-


38 TEXAS MEDICINE August 2013


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