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2012 Texas Medicaid Provider Procedures Manual

Volume 1, General Information : Section 1: Provider Enrollment and Responsibilities : 1.7 Medicaid Waste, Abuse, and Fraud Policy : 1.7.4 Managed Care Organization (MCO) Special Investigative Unit (SIU)

1.7.4
An MCO that provides or arranges for the provision of health-care services to an individual under Texas Medicaid must establish and maintain a special investigative unit (SIU) that works in cooperation with HHSC-OIG and the Attorney General’s Office, as required by Tx. Govt. Code 1TAC§533.012, 1TAC§531.113, and 1§531.1131 and 1 TAC§353.501-353.505 and 370.501-370.505.
The established SIU will identify and investigate cases of suspected waste, abuse, and fraud in Texas Medicaid in accordance with Title 1, Chapter 353, Subchapter F of the TAC.
An annual plan that has been adopted by the MCO and approved by HHSC-OIG describing how it will prevent and reduce fraud and abuse in accordance with 1 TAC, §§353.501 and 353.502.

Texas Medicaid & Healthcare Partnership
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