news reports prompted authorities to scrutinize HHSC’s awarding of a Medic- aid fraud software contract to Austin-based 21 Century Technologies Inc. (21CT). According to media reports, then-Gov. Rick Perry forced Mr. Wilson to resign last December, about a week after the resignation of Jack Stick, a deputy inspec- tor general and HHSC’s chief counsel. (Read more about the story on the Austin American-Statesman website,
http://atxne.ws/1zlN34E.) Just after he took office last January, Governor Abbott appointed Mr. Bowen
as the new inspector general. Mr. Bowen won’t comment on individual cases, but he’s taken steps to overhaul the way the agency does business, including its controversial Medicaid audit process. He says upon assuming office, he was shocked to learn OIG was in the process of settling a case that dated back to 2003, the year of the agency’s birth. “The common theme I’ve heard from doctors, dentists, and those in the man-
aged care community was that previous oversight practices failed to exercise sufficient due process in investigations and audits,” Mr. Bowen said. “So I’ve emphasized to my staff that that must change.” In his efforts to transform OIG’s culture and operations, Mr. Bowen brought
with him nearly a decade of experience as the special inspector general for a mess even larger than OIG: the reconstruction in Iraq. He held that position from 2004 to 2013. “That was oversight under fire, truly unique in that it required work in a very
dangerous war zone,” he said. “I’m applying some of the skills honed there to repair this particular agency.” He says since he’s taken over, OIG has already resolved more than half of its
investigative backlog of more than 1,700 cases and more than 90 percent of its legal case backlog, extending settlement offers for 214 of those cases. The settle- ments will potentially recover between $12 million and $15 million in Medicaid overpayments, OIG says. Mr. Bowen says OIG would “settle all of those old cases one way or another”
and take a variety of approaches to doing so, including closing them outright if they’re meritless. “On the investigation side, my new deputy identified quite a number of old cases that didn’t have merit, and he’s closed them all,” he said. He also dumped the old extrapolation method that had caused such hand-
wringing over the years, replacing it with the U.S. Department of Health and Human Services’ RAT-STATS extrapolation formula. “It’s in common practice across the country,” Mr. Bowen said. “What results
it might generate in any particular case are dependent upon the facts in that case. But the issue is not the results; the issue is the fairness of the tool and its validity in the oversight community. And … with regard to RAT-STATS, it’s well- accepted as fair and valid.” Mr. Bowen hired new deputy inspectors general and created a new Inspec-
tions Division of the office. As part of the effort to make OIG more transparent, the office released its first quarterly report, tma.tips/IGQuarterlyReport, in late September. It says OIG has settled 26 cases worth more than $8.6 million since Mr. Bowen’s arrival. Mr. Bowen says all OIG reports, including audits and inspections, will be
posted on the agency’s website,
http://oig.hhsc.state.tx.us. “We have to be open about the kind of oversight we’re doing, and we have to engage with the stakeholders so they understand what we are doing,” he said.
“So I’ve initiated a stakeholder outreach initiative, and that entails meeting regu- larly with providers and provider groups to get both their insight and assistance into what is in fact wrong with the Medicaid delivery system so that I can focus my investigators, auditors, and inspectors on the right targets.”
November 2015 TEXAS MEDICINE 31
PHYSICIANS PASS ON MEDICAID
Back in 2000, two- thirds of Texas doctors were accepting all new Medicaid patients, ac- cording to TMA’s biennial Survey of Texas Physicians. Now a little more than one- third will take all new Medicaid patients, according to the most recent survey in 2014.
Physicians Year
2000 2002 2004 2006 2008 2010 2012 2014
Accepting All New Medicaid Patients
67% 49% 45% 38% 42% 42% 32% 37%
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