HOUSTON
Volume 16 | Issue 5
Inside This Issue
EnMed Dean Receives Lifetime Achievement Award from Houston Methodist See pg. 9
INDEX Oncology Research......... pg.3 Healthy Heart....................... pg.5 Framework............................. pg.8 Financial Forecast............ pg.12
May Edition 2026
Texas Turns Up Heat on Medicaid Fraud
By Adrienne E. Frazior, J.D. Gulnara Anzarova, J.D. Polsinelli, PC
A
ttorney General Ken Paxton’s office recently announced that its Healthcare Program Enforcement Division ( H P E D) has launched investigations into dozens of Medicaid providers across the state relying on newly released Medicaid claims data from the U.S. Department of Health and Human Services (HHS) made available through the Department of Government Efficiency (DOGE). The initiative reflects an increasingly dat a-d r iven approach to identifying potential fraud, with the Attorney General emphasizing t h at h i s o f f ic e h a s recovered more than one billion dollars from Medicaid fraud since 2020 and will continue to pursue alleged misconduct involving taxpayer-funded health care programs. Earlier this year, DOGE publicly released federal Medicaid claims data as part of a broader effort to detect fraud. Using this dataset, the Office of the Attorney General has initiated multiple investigations and plans to combine the federal data with its internal claims data and other investigative tools, including civil investigative demands, where appropriate, in anticipation of potential litigation. Providers and Services Under
Heightened Scrutiny According to the Attorney General’s office, the investigations focus on home health providers, occupational therapy providers and
alleged improper Medicaid billing related to care for minors. In addition, the HPED has recently brought several high-profile cases against health care providers, pharmacy networks and pharmaceutical companies, including allegations of illegal kickbacks and failure to disclose drug risks. The division has also secured significant financial recoveries, including a $41.5 million settlement related to allegations involving adulterated drugs provided to children. Federal Task Force Signals Increased State–Federal Coordination These developments align with broader federal enforcement trends, including the Trump administration’s recent executive order establishing a Task Force to coordinate anti-fraud efforts across federal benefits programs. The executive order places particular emphasis on state - administered programs, calling for stronger eligibility verification, enhanced data sharing and more robust anti-fraud controls
The investigations focus on identifying potentially improper billing practices across several provider categories, including home health and pediatric services.
Texas Woman’s University Is Recognized for Local, Global Contributions See pg. 11
entities that may have submitted fraudulent claims related to COVID-19 treatments. These matters are expected to involve both detailed data analysis and formal investigative processes as the state evaluates potential enforcement actions and litigation. The investigations come amid a broader trend of heightened scrutiny of Medicaid fraud and abuse by state officials. In recent months, the Attorney General’s office has pursued multiple enforcement actions against health care providers and organizations, including a February lawsuit involving
see Fraud ...page 14
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