Revision 19-1; Effective July 1, 2019

 

Senate Bill 200, 84th Legislature, Regular Session, 2015 moved the Provider Investigations program from the Texas Department of Family and Protective Services to the Texas Health and Human Services Commission.

The PI program is part of the HHSC Regulatory Services Division. The PI Handbook provides information about PI policies and procedures and links to other related programs.

House Bill 5, 85th Legislature, Regular Session, 2017 established DFPS as an agency independent of the Texas Health and Human Services system, effective Sept. 1, 2017. For information about DFPS, please visit the DFPS website.

 

1100 Legal Authority

Revision 19-1; Effective July 1, 2019

 

To investigate abuse, neglect, and exploitation of individuals receiving services from certain providers. PI operates under the authority of the:

The rules or laws cited in this handbook are provided for reference purposes only and are not intended to be a duplication of the rules cited; and are not intended to be relied upon in place of the cited rules. Please refer to the actual rules cited by going to the Texas Administrative Code or the referenced law.

 

1200 Definitions

Revision 19-1; Effective July 1, 2019

 

The following words and terms, when used in this handbook, have the following meanings unless the context clearly indicates otherwise.

Administrator: The person in charge of a provider or that person’s designee. The term does not apply to the assistant commissioner of state supported living centers or the assistant commissioner for mental health substance abuse services.

Adult: A person 18 years of age or older, or a person under 18 years of age who is or has been married or who has had the disabilities of minority removed for general purposes.

Agency: State agencies including the Texas Department of Family and Protective Services, the Texas Department of State Health Services, and the Texas Health and Human Services Commission.

Agent: A person not employed by but working under the auspices of a service provider or contractor; for example, a student or volunteer.

Allegation: A report by someone that an individual receiving services has been or is being abused, neglected, or exploited.

Allegation type: The type of allegation investigated under 26 TAC Chapter 711. The Provider Investigation program investigates the following allegation types:

  • exploitation;
  • neglect;
  • physical abuse;
  • sexual abuse; and
  • verbal or emotional abuse.

Alleged Perpetrator: A person alleged to have abused, neglected, or exploited an individual receiving services.

Alleged Victim: An person receiving services who is alleged to have been abused, neglected, or exploited.

Behavioral health services:

  • services related to research, prevention, and detection of mental disorders and disabilities;
  • services necessary to treat, care for, control, supervise, and rehabilitate persons who have a mental disorder or disability, including persons whose mental disorders or disabilities result from a substance abuse disorder, alcoholism, or drug addiction; and
  • interventions to treat:
    • abuse of alcohol or a controlled substance;
    • psychological or physical dependence on alcohol or a controlled substance; or
    • addiction to alcohol or a controlled substance.

Child: A person under 18 years of age who has not been married and has not had the disabilities of minority removed for general purposes.

Child Care Licensing: A division of HHSC that licenses and regulates 24-hour child care programs, including residential treatment centers and emergency shelters.

Children’s Advocacy Centers: Centers located throughout Texas designated to provide specialized forensic interviews conducted by trained, neutral professionals using research and practice-informed techniques as part of a larger investigative process. The services of the CACs are intended to minimize the need for multiple interviews by community agencies involved in serving victims of abuse.

Clinical practice: A licensed professional’s demonstration of professional competence, as described by the licensing professional board.

Collateral witness: Any person who can provide either direct or circumstantial information about the alleged incident who is not either the alleged victim or alleged perpetrator.

Community center: Serves people with mental health or intellectual disabilities and is established under the Texas Health and Safety Code Chapter 534, Subchapter A. Texas community centers are units of local government, sponsored by counties, cities, hospital districts and school districts. A publicly appointed board of trustees governs each center comprised of local leaders that represent the diversity and best interests of communities, families, and persons receiving services.

Community provider: Excluding HCS and TxHmL waiver program providers, a community provider includes the following:

  • a person who contracts with a health and human services agency or managed care organization to provide home and community-based services;
  • a person who contracts with a Medicaid managed care organization to provide behavioral health services;
  • a managed care organization;
  • an officer, employee, agent, contractor, or subcontractor of a person or entity listed in the bullets above; and
  • an employee, fiscal agent, case manager, or service coordinator of an individual employer participating in the consumer directed service option, as defined by Texas Government Code §531.051(a)(3).

Confirmed: Term used to describe an allegation in which a preponderance of credible evidence exists to support that abuse, neglect, or exploitation occurred.

Consumer Directed Services: A service delivery option in which a person receiving services or legally authorized representative employs and retains service providers and directs the delivery of program services.

Contractor: Any organization, entity, or person who contracts with a provider to provide services directly to a person with physical, mental or intellectual disabilities. The term includes:

  • a day habilitation provider;
  • a foster care provider; and
  • a local independent school district with which a facility, local authority, or community center has a memorandum of understanding for educational services.

Contractor CEO: The person in charge of a contractor that has one or more employees, excluding the CEO. The term includes the CEO of a day habilitation.

Designated Perpetrator: A direct provider determined by PI in a confirmed finding to have abused, neglected, or exploited a person receiving services.

DFPS: Texas Department of Family and Protective Services.

Direct provider: The person, employee, agent, contractor, or subcontractor responsible for providing services to the individual receiving services.

DSHS: Texas Department of State Health Services.

DSHS Consumer Services and Rights Protections: The unit at DSHS central office that protects the rights of people receiving services.

Exploitation: When the alleged perpetrator is a direct provider to a person receiving services, exploitation is defined as the illegal or improper act or process of using a person receiving services or the resources of a person receiving services for monetary or personal benefit, profit or gain, and excludes:

  • theft as defined in the Texas Penal Code Chapter 31;
  • allegations less than $25; and
  • a loan, which includes money or property given to someone to use for a period of time with an understanding that it will be paid back or returned, made by a person receiving services to a direct provider of a community provider.

See examples of exploitation allegations in Section 2150.

See related 26 TAC §711.21.

Facility: This term refers to any of the following:

  • HHSC central offices, state supported living centers, state hospitals, the Rio Grande State Center, the Waco Center for Youth and the El Paso Psychiatric Center, including community services operated by Health and Specialty Care System.
  • A person contracting with a health and human services agency to provide inpatient mental health services.
  • Intermediate care facilities for people with an intellectual disability or related conditions licensed under the Texas Health and Safety Code Chapter 252.

Financial Management Services Agency: An agency contracting with HHSC or an MCO that provides financial management services for an employer who participates in the CDS option.

See related 40 TAC §49.102

Forensic Assessment Center Network: A coordinated group of geriatricians, pediatricians, and other medical professionals in Texas who are experts in identifying abuse and neglect. The FACN is a joint project between DFPS and the University of Texas Health Science Center–Houston that provides medical expertise for PI investigators.

HHSC: Texas Health and Human Services Commission.

HHSC Office of Complaints and Incident Intake: A program within the HHSC Regulatory Services Division that protects the rights of people receiving services.

HHSC Provider Investigator: An employee of the Texas Health and Human Services Commission who:

  • investigates allegations of abuse, neglect, and exploitation according to HRC Chapter 48, Subchapter F and Texas Family Code Chapter 261;
  • has expertise and demonstrated competence in conducting investigations; and
  • has received training on techniques for communicating effectively with individuals with a disability.

Home and community-based services: Services provided in the home or community in accordance with 42 U.S.C. §1315, 42 U.S.C. §1315a, 42 U.S.C. §1396a or 42 U.S.C. §1396n.

See related HRC §48.251(a)(5)

Home and Community-Based Services – Adult Mental Health Program: A program authorized under §1915(i) of the Social Security Act (42 U.S.C. §1396n) that provides HCBS to Medicaid and non-Medicaid people with serious mental illness who have extended tenure in state mental health facilities.

Home and Community-Based Services Waiver Program: Medicaid program authorized under §1915(c) of the federal Social Security Act (42 U.S.C. §1396n(c)) for the provision of services to persons with an intellectual or developmental disability described by Texas Government Code §534.001(11)(B) and Title 40 TAC, Chapter 9, Subchapter D.

Home and Community Support Services Agency: A person, which includes an individual, corporation, or association, licensed under the Texas Health and Safety Code Chapter 142, to provide home health, hospice, habilitation, or personal assistance services for pay or other consideration in a client’s residence, an independent living environment or another appropriate location.

ICF/IID: A licensed intermediate care facility for individuals with an intellectual disability or related conditions, as described in Texas Health and Safety Code, Chapter 252.

Incitement: To spur to action or instigate into activity. This term implies responsibility for initiating another person’s actions.

Inconclusive: Term used to describe that there is not a preponderance of credible evidence to indicate that abuse, neglect, or exploitation did or did not occur due to lack of witnesses or other available evidence.

Individual or person receiving services: This term refers to:

  • an adult or child who receives services from a provider, as that term is defined below;
  • an adult or child who lives in a residence that is owned, operated, or controlled by an HCS waiver program provider, regardless of whether the individual is receiving HCS waiver program services; or
  • a child receiving services from an HCSSA, as that term is defined above.

Limited service provider: The company or person that provides only certain services; a specialty provider. An MCO, HCSSA, HCS, or TxHmL provider may contract with an LSP to provide certain services to a person receiving services.

Local Authority: This term refers to either a local mental health authority, local behavioral authority, or a local intellectual and developmental disability authority.

Local Behavioral Health Authority:  Local behavioral health authorities provide services to a specific geographic area of the state, called the local service area. HHSC requires each authority to plan, develop policy, coordinate, and allocate and develop resources for mental health and chemical dependency services in the local service area.  A LBHA may be designated by DSHS, in accordance with Texas Health and Safety Code §533.0356, and has all the responsibilities and duties of a local mental health authority, as provided by Texas Health and Safety Code §533.035.  A LMHA may apply for designation as a LBHA, in accordance with Texas Health and Safety Code §533.0356(d).

Local Intellectual and Developmental Disability Authority: Designated by the HHSC executive commissioner in accordance with Texas Health and Safety Code §533A.035 and as defined by Texas Health and Safety Code §531.002(12). Local intellectual and developmental disability authorities serve as the point of entry for publicly funded intellectual and developmental disability programs, whether the program is provided by a public or private entity. They:

  • provide or contract to provide an array of services and supports for persons with intellectual and developmental disabilities;
  • are responsible for enrolling eligible people into the following Medicaid programs:
  • are responsible for Permanency Planning for persons receiving services under 22 years of age who live in an ICF/IID, state supported living center or a residential setting of the HCS Program.

For more information about LIDDAs, please see LIDDA Statutes and Rules.

Local Mental Health Authority: Designated by the HHSC executive commissioner in accordance with §533.035, Texas Health and Safety Code and as defined by §531.002(13), Texas Health and Safety Code. Local mental health authorities provide services to a specific geographic area of the state, called the local service area. HHSC requires each authority to plan, develop policy, coordinate, and allocate and develop resources for mental health services in the local service area. 

Managed Care Organization: A health care provider or a group or organization of medical service providers who offers managed care health plans. Texas Medicaid uses managed care to provide health care services to most clients.

Medical intervention or treatment: Intervention or treatment by a licensed medical doctor, osteopath, podiatrist, dentist, physician’s assistant or advanced practice nurse. Medical intervention or treatment does not include first aid, an examination, diagnostics (such as an x-ray or blood test), or the prescribing of oral or topical medication.

Mental health services provider: A person, licensed or unlicensed, who performs or claims to perform mental health services, including a:

  • licensed social worker, as defined by Texas Occupations Code §505.002;
  • chemical dependency counselor, as defined by Texas Occupations Code §504.001;
  • licensed professional counselor, as defined by Texas Occupations Code §503.002;
  • licensed marriage and family therapist, as defined by Texas Occupations Code §502.002;
  • member of the clergy;
  • physician who is practicing medicine, as defined by Texas Occupations Code §151.002;
  • psychologist offering psychological services, as defined by Texas Occupations Code §501.003, and
  • special officer for mental health assignment certified under Texas Occupations Code §1701.404.

See related Texas Civil Practice and Remedies Code, §81.001

Neglect: When the alleged perpetrator is a direct provider to a person receiving services in or from a facility, local authority, community center, or HCS or TxHmL waiver program provider, neglect is defined as a negligent act or omission which caused or may have caused physical or emotional injury or death to a person receiving services or which placed a person receiving services at risk of physical or emotional injury or death.

Examples of neglect include, but are not limited to, the failure to:

  • establish or carry out an appropriate individual program plan or treatment plan for a specific person receiving services, if such failure results in physical or emotional injury or death to a person receiving services or which placed a person receiving services at risk of physical or emotional injury or death;
  • provide adequate nutrition, clothing, or health care to a specific person receiving services in a residential or inpatient program if such failure results in physical or emotional injury or death to a person receiving services or which placed a person receiving services at risk of physical or emotional injury or death; or
  • provide a safe environment for a specific person receiving services, including the failure to maintain adequate numbers of appropriately trained staff, if such failure results in physical or emotional injury or death to a person receiving services or which placed a person receiving services at risk of physical or emotional injury or death.

When the alleged perpetrator is a direct provider to a person receiving services from a community provider, neglect is defined as a negligent act or omission which caused physical or emotional injury or death to a person receiving services.

See examples of neglect allegations in Section 2140.

See related 26 TAC §711.19.

Non-serious physical injury:

  • In state supported living centers and state hospitals — Any injury requiring minor first aid and determined not to be serious by a registered nurse, advanced practice nurse, or physician.
  • For all other service providers — Any injury determined not to be serious by the appropriate medical personnel. Examples of a non-serious physical injury may include:
    • a superficial laceration;
    • a contusion two and one-half inches in diameter or smaller; or
    • an abrasion.

Non-serious verbal or emotional abuse: Direct provider has used derogatory language that may be demoralizing or humiliating to the alleged victim.

Peer or Professional Review: A review of clinical and professional practices by peer professionals.

Physical abuse: When the alleged perpetrator is a direct provider, physical abuse is defined as:

  • an act, or failure to act, performed knowingly, recklessly, or intentionally, including incitement to act, which caused or may have caused physical injury or death to a person receiving services;
  • an act of inappropriate or excessive force or corporal punishment, regardless of whether the act results in a physical injury to a person receiving services; or
  • the use of chemical or bodily restraints or seclusion on a person receiving services not in compliance with federal and state laws and regulations, including:
  • 25 TAC Chapter 415, Subchapter F (relating to Interventions in Mental Health Services)
  • 25 TAC Chapter 404, Subchapter E (relating to Rights of Persons Receiving Mental Health Services);
  • 40 TAC Chapter 3, Subchapter F (relating to Restraints);
  • 26 TAC Chapter 551, Subchapter C (relating to Standards for Licensure);
  • 40 TAC Chapter 2, Subchapter G (relating to Role and Responsibilities of a Local Authority);
  • 40 TAC Chapter 9, Subchapter D (relating to Home and Community-based Services (HCS) Program and Community First Choice (CFC));
  • 40 TAC Chapter 9, Subchapter N (relating to Texas Home Living (TxHmL) Program and Community First Choice (CFC));
  • 26 TAC Chapter 558, Subchapter H (relating to Standards Specific to Agencies Licensed to Provide Hospice Services);
  • 40 TAC Chapter 42, Subchapter D (relating to Additional Program Provider Provisions);
  • 1 TAC Chapter 353, Subchapter C (Member Bill of Rights and Responsibilities); and
  • 40 TAC Chapter 45, Subchapter H (relating to Additional DSA Requirements).

See examples of physical abuse allegations in section 2110.

See related 26 TAC §711.11.

Physical force: Pressure applied to a person’s body.

Preponderance of evidence: The greater weight of evidence, or evidence more credible and convincing to the mind.

Provider: This term includes:

  • a facility;
  • a community center, local authority;
  • a person who contracts with a health and human services agency or managed care organization to provide home and community-based services;
  • a person who contracts with a Medicaid managed care organization to provide behavioral health services;
  • a managed care organization;
  • an officer, employee, agent, contractor, or subcontractor of a person or entity listed above; and
  • an employee, fiscal agent, case manager, or service coordinator of a person employer participating in the Consumer Directed Service option, as defined by Texas Government Code §531.051.

See related HRC §48.251(a)(9)

Reasonable person: A hypothetical person who exercises average care, skill, and judgment.

Reporter: The person who makes an allegation. The reporter may be anonymous.

Serious physical injury:

  • In state supported living centers and state hospitals — Any injury requiring medical intervention or hospitalization or determined to be serious by a physician or advanced practice nurse. Medical intervention is treatment by a licensed medical doctor, osteopath, podiatrist, dentist, physician assistant, or advanced practice nurse. Medical intervention does not include first aid, an examination, diagnostics (such as an x-ray or blood test), or the prescribing of oral or topical medication.
  • For all other service providers — Any injury determined to be serious by the appropriate medical personnel who examined the person. Examples of serious physical injuries include:
    • a fracture;
    • a dislocation of any joint;
    • an internal injury;
    • a contusion larger than two and one-half inches in diameter;
    • a concussion;
    • a second or third degree burn; or
    • any laceration requiring sutures.

Serious verbal or emotional abuse: Serious threats by a direct provider to harm or kill an alleged victim.

Service provider: The provider that employs, contracts with, or supervises the direct provider of services to a person receiving services.

Sexually transmitted infection: Any infection with or without symptoms or clinical manifestations that can be transmitted from one person to another by sexual contact. Also referred to as sexually transmitted disease.

Sexual abuse: When the alleged perpetrator is a direct provider, sexual abuse is defined as:

  • any sexual activity, including:
    • kissing a person receiving services with sexual intent;
    • hugging a person receiving services with sexual intent;
    • stroking a person receiving services with sexual intent;
    • fondling a person receiving services with sexual intent;
  • engaging in sexual conduct as defined in the Texas Penal Code, §43.01 or any activity that is obscene as defined in the Texas Penal Code, §43.21;
  • requesting, soliciting, or compelling a person receiving services to engage in:
    • sexual conduct as defined in the Texas Penal Code, §43.01, or
    • any activity that is obscene as defined in the Texas Penal Code, §43.21;
  • while in the presence of a person receiving services:
    • engaging in or displaying any activity that is obscene, as defined in the Texas Penal Code §43.21, or
    • requesting, soliciting, or compelling another person to engage in any activity that is obscene, as defined in the Texas Penal Code §43.21;
  • committing sexual exploitation as defined in 26 TAC §711.13, against a person receiving services;
  • committing sexual assault as defined in the Texas Penal Code §22.011, against a person receiving services;
  • committing aggravated sexual assault as defined in the Texas Penal Code, §22.021, against a person receiving services; and
  • causing, permitting, encouraging, engaging in, or allowing the photographing, filming, videotaping, or depicting of a person receiving services if the direct provider knew or should have known that the resulting photograph, film, videotape, or depiction of the individual receiving services is obscene as defined in the Texas Penal Code, §43.21, or is pornographic.

Consensual sexual activity between a direct provider and an adult receiving services is not considered sexual abuse if the consensual sexual relationship began prior to the direct provider becoming a direct provider.

See examples of sexual abuse allegations in Section 2120.

See related 26 TAC §711.13.

Significant impairment: When a person experiences a negative physical, emotional, or mental effect or decline in their social, occupational, or other areas of daily functioning, such as independence, self-care, or activities of daily living, as determined through observation, diagnosis, evaluation, or assessment.

State hospitals: State hospitals provide patient-focused, inpatient psychiatric services for people of all ages. Additional information can be found on the HHS website.

State Supported Living Center: State supported living centers provide campus-based direct services and support to people with intellectual and developmental disabilities. Additional information can be found on the HHS website.

Texas Administrative Code: The Texas Administrative Code is a compilation of state agency rules in Texas.

Texas Home Living Waiver Program: Medicaid waiver program authorized for the provision of community-based services and supports to eligible individuals with an intellectual or developmental disability who live in their own homes or the homes of their families. TxHmL is authorized under §1915(c) of the federal Social Security Act (42 U.S.C. §1396n(c)), Texas Government Code §534.001(11)(D), and 40 TAC Chapter 9, Subchapter N.

Unconfirmed: Term used to describe an allegation in which a preponderance of evidence exists to prove that it did not occur.

Unfounded: Term used to describe an allegation that is spurious or patently without factual basis.

Verbal or emotional abuse: When the alleged perpetrator is a direct provider, verbal or emotional abuse is the willful infliction of an act or repeated acts of verbal or other communication, including gestures, to harass, intimidate, humiliate, or degrade a person receiving services or threaten them with physical or emotional harm. The act or communication must:

  • result in an individual receiving services experiencing:
    • significant impairment to their physical, mental or emotional health; or
    • substantial physical or emotional distress as identified by an appropriate medical professional; or
  • be of such a serious nature that a reasonable person would consider it causing significant impairment to the physical, mental, or emotional health of the alleged victim.

See examples of verbal or emotional abuse allegations in Section 2130.

See related 26 TAC 711.17.

Youth Empowerment Services Waiver: A waiver authorized under §1915(c) of the Social Security Act, which prevents or reduces institutionalization of children and adolescents with severe emotional disturbance, enables more flexibility in providing intensive community-based services for children and adolescents with SED, and provides support for their families by improving access to services.

See related 26 TAC §711.3.

 

1300 Investigative Jurisdiction

Revision 19-1; Effective July 1, 2019

 

 

1310 Allegations

Revision 19-1; Effective July 1, 2019

 

When the alleged perpetrator is a direct provider, or is unknown, Provider Investigations investigates the following allegation types:

  • exploitation;
  • neglect;
  • physical abuse;
  • sexual abuse; and
  • verbal or emotional abuse.

See definitions in Section 1200.

PI also investigates:

  • the pregnancy of a person receiving services from a facility or facility contractor if there is:
    • medical verification that conception could have occurred while the individual receiving services was a resident of the facility or of a facility contractor; and
    • a reasonable expectation that conception occurred while the individual was a resident of the facility or of a facility contractor;
    • the sexually transmitted disease of a person receiving services from a facility or of a facility contractor, if the individual could have acquired the STD while a resident of the facility or of a facility contractor; and
  • an injury of unknown origin, if appropriate medical personnel, after examining the individual receiving services, suspect the injury is the result of abuse or neglect.

See related 26 TAC §711.5.

 

1320 Providers and Entities

Revision 18-1; Effective September 1, 2018

 

PI investigates allegations of abuse, neglect, and exploitation involving the following providers:

  • state operated facilities;
  • Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF-IDDs);
  • HHSC-operated community services;
  • a person contracting with an HHS agency to provide inpatient mental health services;
  • community centers and local authorities;
  • a person who contracts with an HHS agency or MCO to provide Home and community-based services (HCBS);
  • a person who contracts with a managed care organization (MCO) to provide behavioral health services (BHS);
  • a managed care organization (MCO)
  • an officer, employee, agent, contractor, subcontractor of the above; and
  • an employee, agent, manager, coordinator of an individual participating in the consumer directed services (CDS) option.

PI investigates allegations of abuse, neglect, and exploitation involving:

  • individuals residing in a HCS group home regardless of whether the individual is receiving services under the waiver program from the provider, and
  • children receiving services from a HCSSA; and
  • independent school districts (ISDs) if the school district is  a contractor of the provider.

 

1330 Cooperating with PI Investigations

Revision 19-1; Effective July 1, 2019

 

State Supported Living Centers and State Hospitals

 

The administrator of an SSLC or state hospital designates a staff person to serve as a liaison to PI.

HHSC Health and Specialty Care System rules provide direction to SSLCs and state hospital employees regarding cooperation with a PI investigation.

See related 25 TAC §417.508(c), 40 TAC §3.304(d) and 40 TAC §3.302(d)

 

Local Authorities and Community Centers

 

The administrator of a local authority and community center designates a staff person to serve as a liaison to PI.

Administrators and contractor CEOs of local authorities and community centers follow directions outlined in 40 TAC §4.554(h) regarding cooperation with a PI Investigation.

See related 40 TAC §9.178(l) and §9.580(g).

 

1340 Other State Agencies and Investigative Entities

Revision 18-1; Effective September 1, 2018

 

Revision 18-1; Effective September 1, 2018

 

PI does not investigate allegations of abuse, neglect, and exploitation if another division of HHSC or another state agency is responsible under state law for the investigation.  PI refers these allegations to the administrator of the provider where the incident occurred. In certain circumstances, PI forwards the report to other agencies for investigation. Some agencies and entities PI may forward reports to include:

 

Texas Department of Family and Protective Services

For information on Texas DFPS investigative authority please refer to the Texas DFPS webpage.

 

Texas Department of State Health Services

For information, on Texas DSHS investigations, please refer to the DSHS Division for Regulatory Services webpage.

 

The University of Texas

Except when the private psychiatric center contracts directly with HHSC, PI does not have jurisdiction to investigate allegations from a hospital or psychiatric center operated by The University of Texas. PI refers these allegations to the administrator of the facility where the incident occurred.

 

Attorney General of Texas

The Office of the Attorney General’s (OAG) Medicaid Fraud Control Unit (MFCU) has broad authority to investigate abuse, neglect, and exploitation within Medicaid.

For information, please refer to the OAG Criminal Justice Divisions webpage.

 

Office of Inspector General

  • U.S. Department of Health and Human Services Office of Inspector General (HHS OIG)

HHS OIG is the largest inspector general’s office in the federal government, with approximately 1,600 employees dedicated to combating fraud, waste, and abuse and to improving efficiency in HHS programs. A majority of HHS OIG’s resources goes toward the oversight of Medicare and Medicaid.

For more information, please refer to the federal HHS OIG’s webpage.

  • Texas Health and Human Services Commission Office of Inspector General (HHSC OIG)

PI reports suspected fraud or abuse of Medicare, Medicaid or social services program funding or resources to the Texas Health and Human Services Commission, Office of Inspector General (HHSC-OIG).

For more information please refer to the HHSC OIG’s Medicaid Program Integrity (MPI) webpage.

 

Indian Reservations

An Indian reservation is a legal designation for an area of land managed by a Native American tribe under the US Bureau of Indian Affairs. PI has no authority to conduct an investigation on Indian reservations without permission from reservation officials.
For more information please refer to the United States Department of the Interior Indian Affairs webpage.

 

Out-of-State Allegations

If the report concerns alleged abuse, neglect, or exploitation of an individual receiving services in another state, the investigator takes sufficient information to notify the appropriate out-of-state agency by telephone or fax.
For information about out-of-state agencies please refer to the National Center on Elder Abuse webpage.

 

1400 Communication Assistance

Revision 18-1; Effective September 1, 2018

 

According to the federal Civil Rights Act:

No person in the United States shall, on the ground of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance.

The protections cited above also apply to persons with limited English proficiency (LEP) or sensory or speaking impairments.

Ensuring that staff and other stakeholders can understand the information our agency provides is important. Whether someone uses assistive technology, speaks another language or uses sign language to communicate, it is our obligation to meet their needs. HHSC provides communication assistance to persons with LEP or impaired sensory or speaking skills at no cost to the person being interviewed. LEP refers to the language a person uses to communicate; sensory impairments can affect how a person communicates.

See related

Title VI of the Civil Rights Act of 1964,
Executive Order 13166, August 11, 2000 and
Americans with Disabilities Act of 1990, as amended (42 U.S.C. 12101 et seq.)

 

1500 Cultural Competency

Revision 18-1; Effective September 1, 2018

 

To investigate effectively, the investigator conducts investigations in a culturally competent manner, adapting their investigative approach to accommodate the interviewee’s needs within their cultural context.