An official State of Texas website.
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 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 Section 711.5.
1320 Providers and Entities
Revision 24-1; Effective Jan. 16, 2024
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), except for HCSSAs;
- 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 or subcontractor of the above; and
- an employee, agent, manager, or coordinator of an individual participating in the consumer directed services (CDS) option.
PI investigates allegations of abuse, neglect, and exploitation involving:
- people living in a HCS group home whether or not the person is receiving services under the waiver program from the provider;
- independent school districts (ISDs) if the school district is a contractor of the provider; and
- an elderly person or an adult with a disability who lives in or is in the care of a residential child-care facility.
1330 Cooperating with PI Investigations
Revision 21-1; Effective April 26, 2021
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 Section 417.508(c), 40 TAC Section 3.304(d) and 40 TAC Section 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 Section 4.554(h) regarding cooperation with a PI Investigation.
See related 40 TAC Section 9.178(l) and Section 9.580(g).
1340 Other State Agencies and Investigative Entities
Revision 21-1; Effective April 26, 2021
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.
Refer to the OAG Criminal Justice Divisions webpage for information.
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.
Refer to the federal HHS OIG's webpage for more information.
- 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).
Refer to the HHSC OIG's Medicaid Fraud Control Units webpage for more information.
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.
Refer to the United States Department of the Interior Indian Affairs webpage for more information.
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.
Refer to the National Center on Elder Abuse webpage for information about out-of-state agencies please.