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Texas Did Not Always Comply With Federal and State Requirements for Claims Submitted for the Nonemergency Medical Transportation Program

During fiscal year (FY) 2011, the Texas Health and Human Services Commission (State agency) claimed Federal Medicaid reimbursement for some nonemergency medical transportation (NEMT) services claims submitted by transportation providers that did not comply with certain Federal and State requirements.

On the basis of our sample results, we estimated that the State agency improperly claimed at least $30.3 million in Federal Medicaid reimbursement for 980,561 NEMT claims during FY 2011. Of the 90 NEMT claims in our sample, the State agency properly claimed Medicaid reimbursement for 20 claims. However, the remaining 70 claims contained services that did not comply with certain Federal and State regulations. Of the 70 claims, 23 contained more than 1 deficiency.

The claims for unallowable services were made because the State agency's policies and procedures for overseeing the Medicaid program did not ensure that providers complied with Federal and State requirements for documenting and claiming NEMT services.

We recommended that the State agency (1) refund $30.3 million to the Federal Government and (2) strengthen its policies and procedures to ensure that providers comply with Federal and State requirements. The State agency described actions that it has taken or will take to address our recommendations.

Filed under: Centers for Medicare and Medicaid Services