Texas Did Not Make Increased Primary Care Provider Payments and Claim Reimbursement in Accordance With Federal Requirements

Texas did not always make increased Medicaid payments to providers and claim reimbursement in accordance with Federal requirements. Of the $721 million in Federal funds that it received, Texas inappropriately received $20.7 million because (1) it incorrectly claimed the 100-percent matching rate for payments that were only eligible for the regular matching rate and (2) it made payments that were unallowable.

Additionally, we are setting aside $1.1 million in Federal funds Texas received for payments that exceeded the providers' actual billed charges. Providers did not complete the billed charges field for some payment data with meaningful amounts, so we could not determine the correct payment amounts for the data.

We recommended that Texas refund $20.7 million to the Federal Government that it received for incorrectly claimed and unallowable payments. We also recommended that Texas work with the Centers for Medicare & Medicaid Services to determine the portion of the $1.1 million that it received for payments that exceeded providers' billed charges should be refunded to the Federal Government. Texas did not indicate concurrence or nonconcurrence with our recommendations and described corrective actions that it plans to take.