The Texas Health and Human Services Commission did not always claim Federal Medicaid reimbursement for managed care payments in compliance with Federal requirements, according to a Department of Health & Human Services Office of Inspector General (OIG) report.
Sections 2(f)(2)(A) and (B) of the Improper Payments Elimination and Recovery Act of 2010 defined an improper payment as any payment that should not have been made, including any duplicate payment. OIG audited the Texas Medicaid Managed Care payments to determine if the State of Texas received excessive payments in violation of the Act.
OIG Report A-06-15-00024 states that the OIG audit found of the 3,170 beneficiary matches reviewed by OIG, 3,045 were assigned more than 1 Medicaid identification number. As a result, OIG found the Texas agency made duplicate managed care payments totaling $3,005,5737 to MCOs for the same beneficiary under different Medicaid identification numbers for the same month.
In addition, the Report also states the Texas agency paid MCOs $3,509,450 for beneficiaries under an inactive Medicaid identification number rather than the beneficiaries’ active numbers.
In total, the OIG Report concludes that the Texas agency improperly claimed $6,515,023 ($3,843,339 Federal share) for managed care payments that did not comply with Federal requirements because the State agency did not ensure that beneficiaries were assigned only one Medicaid identification number. Specifically, OIG reported the Texas agency stated that its eligibility staff failed to appropriately research potential beneficiary matches identified during the application process before assigning a Medicaid identification number. In other instances, the State agency explained that it did not identify potential beneficiary matches because insufficient applicant information was available during the application process or that the applicant provided incorrect information. In addition, the State agency stated that eligibility staff made data entry errors that prevented potential beneficiary matches from being identified.
Based on its findings, OIG recommended that the Texas Medicaid Agency
- Refund $3,843,339 to the Federal Government,
- Identify additional unallowable monthly Medicaid managed care payments made before and after our audit period for the 3,045 beneficiary matches,
- Identify any other beneficiaries who are assigned more than one Medicaid identification number and refund any unallowable payments associated with those beneficiaries, and
- Strengthen its procedures to determine whether applicants are enrolled in any medical or public assistance benefits throughout the State and ensure that no beneficiary is issued more than one Medicaid identification number.
In its written comments on the draft report regarding the first and second recommendations, the Report states that the Texas Medicaid agency stated that it would research OIG’s findings and refund any unallowable payments. Regarding OIG’s third recommendation, the State agency said that it would identify any additional beneficiaries assigned more than one Medicaid identification number and refund any unallowable payments associated with those beneficiaries. Regarding OIG’s last recommendation, the Texas Medicaid agency stated that it had implemented several strategies to mitigate the creation of more than one Medicaid identification number for a beneficiary, including improved automation and training. In addition, the State agency explained that it has established an eligibility and enrollment workgroup actively engaged in addressing eligibility and enrollment issues, including the proactive analysis and resolution of payment discrepancies stemming from the assignment of more than one Medicaid identification number to a beneficiary.