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TITLE 1ADMINISTRATION
PART 15TEXAS HEALTH AND HUMAN SERVICES COMMISSION
CHAPTER 371MEDICAID AND OTHER HEALTH AND HUMAN SERVICES FRAUD AND ABUSE PROGRAM INTEGRITY
SUBCHAPTER BOFFICE OF INSPECTOR GENERAL
RULE §371.17Detection

The OIG utilizes automation as well as other techniques to detect and identify program violations and possible fraud, waste, abuse, and overpayments. These automated detection systems are mandated by state and federal statutes. One automated system is additionally required to utilize neural network and learning technologies. These systems detect patterns of inappropriate billing from which an overpayment is identified immediately without the need for additional investigation. They also detect anomalous billing and service patterns, which then require investigation for evidence of program violations.


Source Note: The provisions of this §371.17 adopted to be effective January 9, 2005, 29 TexReg 12128; amended to be effective May 1, 2016, 41 TexReg 2941

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