HHSC Staffer’s Incomplete One Page Writeup Guided Medicaid Supplemental Physician Payments

hhs-oigThe Department of Health and Human Services Office of Inspector General audit released earlier this week found Texas had miscalculated payments for the Medicaid Supplemental Physician Payments program and owed the federal government some $57.9 million for the period 2004 to 2007.  It also mentioned that the calculations for the Medicaid payments for the program for the last half of 2007 were done by the Health and Human Services Commission not its contractor, Boston-based Public Consulting Group (PCG).

One page document guided payment calculations

It wasn’t mentioned in media reports on the audit that the person in HHSC who was doing those calculations was found to be doing them incorrectly.  In fact, the report states, despite six months of training by PCG, the individual who took over, an HHSC rate analyst, condensed the whole of PCG’s indoctrination into a one-page document that omitted important calculations.  Ouch!

The overpayments occurred because the State agency did not have any formal written policies and procedures to ensure that the methodology used to calculate the supplemental payments was consistent with the terms of the SPA and complied with Federal and State requirements. According to a State agency official, PCG provided 6 months of hands-on training to a State agency rate analyst before the State agency assumed responsibility for calculating the supplemental payments. The official said that the rate analyst, who calculated the 2007 third and fourth-quarter supplemental payments for the State agency, created a one-page document based on the training that PCG provided. That document did not contain any procedures for calculating the ratio or identifying eligible physicians and did not adjust supplemental payments for payment modifiers or diagnostic test modifiers.

More money owed?

Since the person obviously carried on beyond the end of 2007 in their position, one can only wonder if Texas owes back more money to the feds for program miscalculations from 2007 until the program closed in 2011.

It’s odd that the auditors didn’t mention anything about it or recommend a further audit of those last years of the program.  If they recouped almost $58 million for 2004 to 2007, there is probably a lot more they could find in those later years.

Role of TMHP/Xerox

Also as the federal auditors did not consider private contractors as different entities from the state agency, one wonders the role of the Texas Medicaid and Healthcare Partnership/Xerox in this mess as the state’s Medicaid claims administrator of the time.  The auditors  “performed [their] fieldwork at the State agency and the Texas Medicaid and Healthcare Partnership (TMHP) in Austin, Texas” per the report.  

The full report can be downloaded here.

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