A Texas state Medicaid leader said her office is taking steps to address potential Medicaid fraud, following a letter from the governor pushing for stronger enforcement.
Last month, Gov. Greg Abbott directed state officials to investigate potential Medicaid fraud in Texas and implement additional anti-fraud measures, while recognizing low levels of fraud in the state’s program. The letter was addressed to the head of the Texas Health and Human Services Commission and the Health and Human Services Office of Inspector General.
Emily Zalkovsky, the state Medicaid director for the HHSC, said the letter asked the commission to conduct policy and service reviews for services that were identified as “more risky” at the federal level.
“We're considering how to move forward with the directive from the Office of the Governor and looking at various services we can focus on,” she told the Medical Care Advisory Committee Thursday.
But, there is a limit on what the Medicaid office can do, she said.
“The Medicaid program doesn't investigate fraud ourselves…. That's the Office of the Inspector General's role,” Zalkovsky said. “We report anything we see to them, but we do things on the front end in our operations and our policies to try to get in front of that.”
Those policies can include implementing service limits, prior authorization requirements and additional checks during provider enrollment – as well as identifying anomalies for the Office of the Inspector General to investigate.
“We do involve the Office of the Inspector General on the front end,” Zalkovsky said. “We see if they have any concerns and we incorporate their advice there.”
Lt. Gov. Dan Patrick also identified preventing fraud and abuse in Texas human services programs, including Medicaid, in the first round of Interim Legislative Charges – meaning the Senate Committee on Health and Human Services will study the issue ahead of the 2027 legislative session. Patrick’s announcement said the charge was in support of Abbott’s call to action.
Abbott’s letter directed state officials to “proactively address fraud, waste and abuse” in Medicaid programs after the Trump administration identified potential fraud in other states. The letter outlined actions for the agencies to take – including additional reviews of services identified by the Trump administration.
HHSC and HHSC’s Office of the Inspector General are expected to provide a progress report to Abbott next month.
Zalkovsky said her office is working on addressing the concerns raised by the governor.
“You’ll probably be hearing more about it in the coming year,” Zalkovsky told the advisory committee. “We'll keep you updated on any changes on our end on this as well.”
Abigail Ruhman is KERA’s health reporter. Got a tip? Email Abigail at aruhman@kera.org.
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