The state of Texas may have claimed more than $30 million in federal funds for Medicaid uncompensated care payments that didn’t actually meet federal and state requirements.
As a result, the Lone Star State has agreed to refund some of the money. The findings come from the Office of Inspector General (OIG), which determined Texas claimed $16.9 billion in uncompensated care (UC) payments, though the state incorrectly claimed more than $30 million.
“Specifically, Texas claimed (1) $12.91 million ($7.51 million Federal share) because it did not refund the full Federal share of overpayments and (2) $5.99 million ($3.54 million Federal share) because it did not collect overpayments it identified,” the report stated. “Additionally, the State agency may have incorrectly claimed $33.78 million ($19.66 million Federal share) because it did not reduce hospitals’ actual UC costs by Medicare payments the hospitals received.”
Texas was able to claim these funds under a Medicaid waiver that established UC payments to offset eligible UC costs hospitals and other providers incurred. The Centers for Medicare and Medicaid Services (CMS) approved this waiver in 2011, with a cap of $17.58 billion for the first five years of the waiver program. The OIG reviewed $16.95 billion in UC payments incurred from December 12, 2011, through September 30, 2016, or years one through five.
Texas has agreed with the OIG’s recommendations to repay $11.05 million to the federal government for the underreported UC overpayments. The state has also agreed to follow the CMS-approved methodology for calculating actual UC costs when reconciling initial UC payments with providers’ actual UC costs, as well as establishing review procedures for overpayments to ensure that they are accurately entered into the State agency’s accounting system and returned to the Federal Government, OIG stated.
“According to Federal law, States must refund to CMS the federal share of Medicaid overpayments,” OIG reported. “The waiver also requires the state agency to refund to the federal government its share of overpayments.”
Amy joined TriMed Media as a Senior Writer for HealthExec after covering home care for three years. When not writing about all things healthcare, she fulfills her lifelong dream of becoming a pirate by sailing in regattas and enjoying rum. Fun fact: she sailed 333 miles across Lake Michigan in the Chicago Yacht Club "Race to Mackinac."