Feds: Texas Responsible for Misspent Medicaid Dollars

[TexasTowelie]

Texas is “ultimately responsible” for millions of misspent Medicaid dollars, according to a new federal audit, because a state agency failed to properly oversee the contractor that reviewed the medical necessity of Medicaid claims.

For nearly five years, the Texas Medicaid and Healthcare Partnership (TMHP), a subsidiary of Xerox, allowed workers with limited expertise to approve dental claims for Texas’ Medicaid program, the joint state-federal insurer. State spending on orthodontic services spiraled out of control: Between 2003 and 2010, Texas Medicaid payments for orthodontic services grew by more than 3,000 percent — from $6.5 million to $220.5 million — while program enrollment only grew 33 percent. By 2012, federal and state auditors found that the contractor’s actions had opened the door to a “massive Medicaid fraud scheme” that cost taxpayers hundreds of millions of dollars.

Federal auditors now say the Texas Health and Human Services Commission is responsible for the uncontrolled spending growth because the state agency failed to ensure that its contractor, TMHP, followed state Medicaid guidelines to evaluate the medical necessity of orthodontic claims. According to the audit, which was released by the U.S. Department of Health and Human Services’ Office of Inspector General on Aug. 6, the state’s lack of oversight allowed TMHP to approve claims that may not have been medically necessary.

“Although TMHP failed to properly use the prior-authorization process to determine the medical necessity of orthodontic services, the State agency is ultimately responsible for contractor compliance,” the audit says.

More at http://kut.org/post/feds-texas-responsible-misspent-medicaid-dollars .

[Shrike47]

1. Whatever the state pays will probably come out of the state Medicaid program and hurt the poor.

They'll use the overpay as an excuse to gut programs, just watch.

[Gothmog]

2. This is the old Affiliated Computer Service company

That company was very sketchy before it was acquired by Xerox and I guess that things have not changed under new ownership

[DhhD]

3. Maybe this is an opportunity for Wendy Davis to speak to the taxpayers about the Medicaid Expansion.

[DhhD]

4. Dental Care at Medicaid.gov as described by the ACA.

http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Benefits/Dental-Care.html

Very important read from the ACA about Dental Care for children and adults includes lots of links that explain everything.

[TexasTowelie]

5. Yes, her campaign should jump on this issue.

I believe that the AG's office has already cut a deal with Accenture to take over the project. I recall posting a different thread a few months ago about this story and I believe that Accenture is a different subsidiary under the Xerox group of companies. Considering that Accenture bungled the handling a different program within the Health & Human Services department a couple of years ago it seems ironic that they were picked to take over the project. There may have been a sweetheart deal cut among the AG, HHSC and Xerox on the new contract.

It's time for the Davis campaign to investigate and see what else can be uncovered so that it can be used in the race.