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Report File
Date Issued
Submitting OIG
Department of Health & Human Services OIG
Other Participating OIGs
Department of Health & Human Services OIG
Agencies Reviewed/Investigated
Department of Health & Human Services
Components
Centers for Medicare and Medicaid Services
Report Number
A-06-19-05002
Report Type
Audit
Location

TX,
United States

Number of Recommendations
0
Questioned Costs
$482,601
Funds for Better Use
$0
External Entity
SelectCare of Texas, Inc.

Open Recommendations

This report has 3 open recommendations.
Recommendation Number Significant Recommendation Recommended Questioned Costs Recommended Funds for Better Use Additional Details
24-A-06-01902 No $0 $0

We recommend that SelectCare of Texas, Inc. identify, for the high-risk diagnoses included in this report, similar instances of noncompliance that occurred before and after our audit period and refund any resulting overpayments to the Federal Government

24-A-06-01901 No $482,601 $0

We recommend that SelectCare of Texas, Inc. refund to the Federal Government the $482,601 in net overpayments

24-A-06-01903 No $0 $0

We recommend that SelectCare of Texas, Inc. review its existing compliance procedures to identify potential areas where improvements can be made to ensure that diagnosis codes that are at high risk for being miscoded comply with Federal requirements (when submitted to CMS for use in CMS's risk adjustment program) and take any necessary steps to enhance those current procedures

Department of Health & Human Services OIG

United States