Feds say Texas responsible for unnecessary Medicaid spending

Elsewhere, a report says Kansas improperly claimed $10.7 million in Medicaid reimbursements for school-based services.

Texas Tribune: Feds: Texas Responsible For Misspent Medicaid Dollars
Texas is "ultimately responsible" for millions of misspent Medicaid dollars, according to a new federal audit, because a state agency failed to properly oversee the contractor that reviewed the medical necessity of Medicaid claims. For nearly five years, the Texas Medicaid and Healthcare Partnership (TMHP), a subsidiary of Xerox, allowed workers with limited expertise to approve dental claims for Texas' Medicaid program, the joint state-federal insurer. State spending on orthodontic services spiraled out of control: Between 2003 and 2010, Texas Medicaid payments for orthodontic services grew by more than 3,000 percent -; from $6.5 million to $220.5 million -; while program enrollment only grew 33 percent. By 2012, federal and state auditors found that the contractor's actions had opened the door to a "massive Medicaid fraud scheme" that cost taxpayers hundreds of millions of dollars (Aaronson, 8/11).

Houston Chronicle: Feds: Texas 'Ultimately Responsible' For Medicaid Waste
In what may amount to a warning shot ahead of a demand for money, the federal government is making clear that it holds Texas officials responsible for hundreds of millions of dollars in Medicaid spending wasted on unnecessary braces and other orthodontic work for the state's poorest residents. A federal audit report released this month concluded that even though a private contractor tasked with reviewing and pre-approving dental Medicaid claims did not follow state and federal protocols, the Texas Health and Human Services Commission was "ultimately responsible" for the inappropriate spending because it is its job to monitor compliance (Rosenthal, 8/11).

Kansas Health Institute News Service: Kansas Improperly Claimed $10.7M In Medicaid Reimbursements
Kansas improperly billed Medicaid for nearly $11 million in school-based health services, a government watchdog has found. In a report released Monday, the inspector general for the U.S. Department of Health and Human Services determined that Kansas received $10.75 million in unallowable reimbursements for services provided during the one-year period from July 1, 2009, through June 30, 2010. The overcharges occurred because the Kansas Department of Health and Environment's Division of Health Care Finance "did not have adequate policies and procedures" to monitor the program and to ensure it complied with state and federal requirements, the report stated (Margolies, 8/11).

http://www.kaiserhealthnews.orgThis article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.


The opinions expressed here are the views of the writer and do not necessarily reflect the views and opinions of News Medical.
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