Fraud & Abuse Program
El Paso Health has implemented a Fraud, Waste & Abuse program as required by law.
If you suspect that any person or entity has acted in a possible fraudulent, wasteful, abusive, or otherwise illegal or unethical manner, please report such actions to El Paso Health’s confidential Fraud Hotline (toll free) at 1 866-356-8395.
If you prefer to submit an allegation directly to the State of Texas you may do so online at https://oig.hhsc.texas.gov/report-fraud-waste-or-abuse
OIG Releases Revised Self-Disclosure Protocol (April 17, 2013) In 1998, the Office of Inspector General (OIG) of the United States Department of Health and Human Services (HHS) published the Provider Self-Disclosure Protocol (the SDP) at 63 Fed Reg. 58399 (October 30, 1998) to establish a process for health care providers to voluntarily identify, disclose, and resolve instances of potential fraud involving the Federal health care programs (as defined in section 1128B(f) of the Social Security Act (the Act), 42 U.S.C. 1320a–7b(f)). The SDP provides guidance on how to investigate this conduct, quantify damages, and report the conduct to OIG to resolve the provider’s liability under OIG’s civil monetary penalty authorities. Since the original publication, OIG has identified areas where additional guidance would be beneficial to the health care community and would improve the efficient resolution of SDP matters. On the basis of our experience and the comments they received, the OIG has decided to revise the SDP in its entirety at this time. This revised SDP supersedes and replaces the 1998 Federal Register Notice and the Open Letters. The report contains some very useful information such as how the OIG calculates the penalty for employing an excluded individual for a staff person that is not the direct provider of service.
The revised SDP can be found here
Announcements and Updates for Fraud, Waste, & Abuse:
- DPS launches secure online Rx monitoring
- Drug Diversion in the Medicaid Program
- Federal OIG Resources
- Fraud, anti-kickback penalties to double
- Frequently Asked Questions: Payment Holds Due to a Credible Allegation of Fraud
- Identifying Inappropriate Claims Before They Are Paid
- Medicaid Fraud Notice for Members
- Medicaid Fraud Notice for Providers
- Medicaid Managed Care Organizations Must Maintain Special Investigative Units
- Medicaid Program Integrity Education
- National Medicaid Audit Program
- Roadmap for New Physicians Avoiding Medicare and Medicaid Fraud and Abuse
- Office of Inspector General
- OIG Medicaid Integrity Report
- Texas Medicaid Fraud Prevention Statute
- Texas Self Disclosure Protocol
Screening is required to ensure that El Paso Health, as an organization with federal funding, is not conducting business with anyone who has been debarred, excluded or is otherwise ineligible for participation in federal health programs.