Federal Reports

The Texas Health and Human Services Commission did not always claim Federal Medicaid reimbursement for managed care payments in compliance with Federal requirements. Of the 3,170 beneficiary matches in our review, 3,045 were assigned more than 1 Medicaid identification number. As a result, the State agency improperly claimed $6.5 million ($3.8 million Federal share) for managed care payments that did not comply with Federal requirements.

In our previous audits of six Medicare contractors, we found that payments made to providers for hospital outpatient dental services generally did not comply with Medicare requirements. Of the 600 dental services in our 6 stratified random samples, 542 did not comply with Medicare requirements. We did not determine Medicare compliance for 3 dental services because the payments were refunded before our audit work, and we did not determine Medicare compliance for 28 dental services because the providers of those services submitted claims to a different Medicare contractor. Medicare contractors properly paid providers for the remaining 27 dental services. On the basis of these results, we estimated that the six Medicare contractors in our audits improperly paid providers an estimated $9.8 million for hospital outpatient dental services that did not comply with Medicare requirements.

The Nebraska Department of Health and Human Services (State agency) claimed Federal Medicaid reimbursement for some nonemergency medical transportation (NET) services claims submitted by NET providers that did not comply with Federal and State requirements during fiscal years (FYs) 2012 through 2014. On the basis of our sample results, we estimated that the State agency improperly claimed at least $1.9 million (Federal share) in unallowable Medicaid reimbursement for NET services during this period. In addition, NET providers did not have documentation to support that State-mandated driver background checks, vehicle maintenance checks, and driver qualification verifications had been performed.