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In Medicaid fraud investigations, a controversial tool

The Texas Tribune, July 24, 2012

Health and Human Services Commission's Office of Inspector General's dollar-recovery strategy—which includes an increased reliance on a rule that allows investigators to freeze financing for any health provider accused of overbilling—has enraged doctors, dentists and other providers who treat Medicaid patients. They say an anonymous call to a fraud hotline or a computer-generated analysis of a handful of billing codes is enough to halt their financing without so much as a hearing, jeopardizing their practices and employees and leaving thousands of needy patients in a lurch while the state works to prove—or rule out—abuse.