At the beginning of December, 2013, the Health and Human Services Commission published online its budgetary figures for 2014. Included in the document are the 2012 and 2013 expenditures and metrics for the Office of the Inspector General and its estimated expenditures and metrics for 2014.
TDMR thought it might be of interest to dental Medicaid providers and that section of the HHSC budget document can be downloaded here.
Budget
Based on testimony from Inspector General Doug Wilson and his deputy Jack Stick last legislative session in early 2013, OIG’s budget was expanded by legislators. The figures shows that the total OIG budget in 2012 was $43.6 million and the proposed 2014 budget is $64.2 million. The OIG budget was also expanded in 2013.
The significant increase in spending from 2012 to 2013 was a result of OIG hiring over $20 million in professionals in 2013, up from only $635,000 in 2012. For 2014, professional expenses will still be at the $7 million level. But the largest increase comes from a rise in staff expenditures which will go up by over $11 million from 2013 and 2012 (see document).
|
2012 |
2013 |
2014 |
|
| TOTAL, OBJECT OF EXPENSE |
$43,674,308 |
$62,044,072 |
$64,246,904 |
Efficiency
Despite the almost 50% increase in funds from 2012, the efficiency metric that is assigned to OIG, Average $ Recovered & Saved/Completed Investigation, Review and Audit, is expected to drop from 2012 and 2013. It will even be lower in 2014 than it was in 2012 when the budget was $20 million less.
|
2012 |
2013 |
2014 |
|
| 1 Average $ Recovered & Saved/Completed Investigation, Review and Audit |
12,982.42 |
13,544.51 |
12,741.12 |
Output Measures
The number of investigations (#1 below) will slightly drop from 2013 to 2014 and the number of audits performed will significantly drop (#2). Hospital reviews (#4) will drop but nursing home reviews (#3) will drastically increase. Obviously nursing homes are being targeted this year.
OIG claims (#5) that it collects almost a billion dollars a year in total dollars recovered in 2012, 2013 and 2014. Considering testimony before various legislative committees in 2013, one has to wonder if this is only monies identified rather than actual monies collected. Despite this and the increased OIG budget for 2014, this figure drops by over $50 million from 2012.
Total Dollars Saved (#6), goes up from 2012 but down by $60 million from 2013. $367 million saved is an impressive amount however we don’t know how these figures are calculated.
Interestingly, OIG expects to refer only 48 cases to the Medicaid fraud control unit in 2014, the same as in 2013. But OIG expects to have 1,200 more fraud cases in 2014 than in 2013. This seems unusual.
|
2012 |
2013 |
2014 |
|
| 1 Number of Provider and Recipient Investigations |
88,751.00 |
98,808.00 |
98,745.00 |
| 2 Number of Audits Performed |
2,072.00 |
3,095.00 |
2,275.00 |
| 3 Number of Nursing Facility Reviews |
394.00 |
255.00 |
651.00 |
| 4 Number of Hospital Utilization Reviews |
707.00 |
687.00 |
600.00 |
| 5 Total Dollars Recovered (Millions) |
996,428,408.00 |
968,842,954.00 |
935,553,220.00 |
| 6 Total Dollars Saved (Millions) |
196,967,917.00 |
424,142,351.00 |
367,494,342.00 |
| 7 Referrals to OAG Fraud Control Unit |
136.00 |
48.00 |
48.00 |
| 8 Cases: Fraud and Abuse System |
5,131.00 |
3,620.00 |
4,800.00 |
In another metric, despite the rise in fraud investigations and funds, OIG expects that the number of Medicaid providers they will exclude will be 400 less than 2012.
|
2012 |
2013 |
2014 |
|
| 1 Medicaid Providers Excluded |
669.00 |
309.00 |
259.00 |