Texas to repay $30M in care payments that didn’t meet requirements

The state of Texas may have claimed more than $30 million in federal funds for Medicaid uncompensated care payments that didn’t actually meet federal and state requirements.

As a result, the Lone Star State has agreed to refund some of the money. The findings come from the Office of Inspector General (OIG), which determined Texas claimed $16.9 billion in uncompensated care (UC) payments, though the state incorrectly claimed more than $30 million.

“Specifically, Texas claimed (1) $12.91 million ($7.51 million Federal share) because it did not refund the full Federal share of overpayments and (2) $5.99 million ($3.54 million Federal share) because it did not collect overpayments it identified,” the report stated. “Additionally, the State agency may have incorrectly claimed $33.78 million ($19.66 million Federal share) because it did not reduce hospitals’ actual UC costs by Medicare payments the hospitals received.”

Texas was able to claim these funds under a Medicaid waiver that established UC payments to offset eligible UC costs hospitals and other providers incurred. The Centers for Medicare and Medicaid Services (CMS) approved this waiver in 2011, with a cap of $17.58 billion for the first five years of the waiver program. The OIG reviewed $16.95 billion in UC payments incurred from December 12, 2011, through September 30, 2016, or years one through five.

Source: Texas to repay $30M in care payments that didn’t meet requirements / Health Exec

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