Health Reform WK-EDGE OIG seeks Texas-sized $20M refund for ACA-related Medicaid contributions
Tuesday, April 17, 2018

OIG seeks Texas-sized $20M refund for ACA-related Medicaid contributions

By Dietrich Knauth

Texas improperly received more than $20 million in federal funds for increased Medicaid payments under the Affordable Care Act (ACA). The HHS Office of Inspector General (OIG) determined the state incorrectly claimed a higher matching rate for ineligible payments and made payments that were unallowable. HHS recommended that Texas pay back the $20 million, and Texas said it would review HHS’s findings and determine how much it would refund the federal government (OIG Report, No. A-06-15-00045, April 9, 2018).

The ACA required states to pay increased Medicaid rates for certain evaluation and management and vaccine administration services furnished by a provider specializing in family medicine, general internal medicine, or pediatric medicine. As part of the change, the ACA also established a 100-percent federal medical assistance percentage (FMAP) for the portion of such payments that exceeded Medicaid rate in effect in 2009. HHS audited $721 million in federal payments to Texas for 2013 and 2014, seeking to determine whether Texas made the increased Medicaid payments to providers and claimed reimbursement in accordance with federal requirements.

The OIG found three types of inconsistencies that led to federal overpayment. First, it found that Texas incorrectly claimed the 100-percent matching rate for payments that were only eligible for the regular matching rate—around 58 percent for Texas during the period audited. That portion accounted for $13.5 million of the audit’s total for improper payments, and the bulk of the difference came from HHS’s determination that Texas was ineligible for 100-percent matching after reducing its Medicaid rates for children’s vaccine services from 2009 levels. Second, Texas received federal funds for $7.2 million in payments that HHS deemed unallowable. And third, Texas received federal funds for payments that exceeded the providers’ actual billed charges, according to the report. On that count, HHS found that Texas paid $1.1 million for claims that did not have meaningful billing amounts, making it difficult to determine the correct payment amounts for those services.

ReportsLetters: OIGReports AgencyNews FederalFMAPNews MedicaidExpansionNews ProgramIntegrityNews

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