After an in-depth audit, the HHS Office of the Inspector General has come down hard on Medicaid officials in Pennsylvania, Connecticut and Texas, suggesting that each had filed claims for more reimbursement than they could appropriately justify.
For example, in Pennsylvania, the OIG notes that 10 percent of claims for case management of services for mentally ill or mentally retarded people were disallowed later. The claims, which lacked case record support, were for about $11.8 million, $6.5 million of which came from federal funds. The OIG wants Pennsylvania to give the $6.5 million back.
Connecticut, too, has been accused of filing claims that didn't have enough backup. Officials said that the state, which billed $19.8 million for 80 contracted mental health and social services, couldn't produce enough documentation to prove that the claims qualified for payment.
Meanwhile, in Texas, a full 22 percent of sampled medical claims for care provided to undocumented immigrants were questionable, the OIG said, as the claims didn't meet the state's own definition of emergency care. Texas only allows medical care and prescription drugs under Medicaid for undocumented patients during medical emergencies. The amount in question involved 193 of 854 claims for care, resulting in bills of $262,000.
To learn more about the audit:
- read this Health Leaders Media piece [1]
Links:
[1] http://healthplans.hcpro.com/content.cfm?content_id=239115&topic=WS_HLM2_HEP