Medicaid Overpaid Texas $18.9 Million For School Based Health Services

Texas received $18.9 million from Medicaid for school-based health services that were billed improperly, and the federal government is seeking to get the money back.

SOURCE: Mike Reagan (aimssc.com)

Medicaid overpaid Texas $18.9 million for school-based health services, seeks refund

FILED UNDERHEALTH CARE AT20 HRS AGO

Written by

Sabriya Rice, Business of Health Care Reporter

Texas received $18.9 million from Medicaid for school-based health services that were billed improperly, and the federal government is seeking to get the money back.

The School Health and Related Services, or SHARS program, allows Texas school districts to request Medicaid reimbursement for providing medically necessary health services to qualified children, age 20 or younger, who have disabilities. Among other things, the services can include counseling, physical and speech therapy, transportation and nursing.

However, some of the direct medical services billed by the Texas Health and Human Services Commission between 2010 and 2011 were not “reasonable, adequately supported, and otherwise allowable” in accordance with state and federal law, concluded a report released Wednesday.

Inspectors from the Department of Health and Human Services’ Office of the Inspector General randomly reviewed medical services that the state program claimed through Medicaid between Oct. 1, 2010, and Sept. 30, 2011.  The audit of 3,161 claims found 274 were coded incorrectly.

For example, instead of billing for a specific activity provided to a student, some school district staff would simply list all of the activities in their job description.  Others billed for activities that were performed before or after the actual billable medical service, such as travel or paperwork.

As a result, $18.9 million in unallowable federal reimbursement was sent to Texas, the audit said.  The state had received $389.9 million in federal reimbursement for costs associated with 572 participating school districts during the time period evaluated. The report did not list the school districts involved.

The Texas Health and Human Services Commission received a draft of the report in May and was given a chance to respond. The state agency questioned the data in a letter to the HHS, calling the random examples “illustrative, not exhaustive, and leaving room for interpretation and judgment.”

However, the agency also said it would coordinate to refund the federal government within one year, once a final payment amount could be determined by the audit.

The inspector general audits attempt to identify waste, mismanagement and abuse of federal health services. In 2016, the agency said that Texas received nearly $58 million too much for claims from six facilities in the University of Texas academic health system.

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