Review of Medical Claims Made to Medicaid for Beneficiaries Under the Age of 21 Who Reside in Institutions for Mental Diseases Within the State of Texas

This report is one of a series of reports involving our multi-state initiative focusing on claims to Medicaid for residents of institutions for mental diseases (IMD).  The objective of the review was to determine if controls were in place to preclude the Texas department of Health from claiming Federal financial participation under the Medicaid program for medical services, except inpatient psychiatric services, provided to IMD residents under the age of 21.  We found that, for the period September 1, 1997 through August 31, 2000, the Texas Department of Health improperly claimed Federal funds for medical services provided to IMD residents under the age of 21.  As a result, Federal funding totaling $1,290,047 was improperly claimed.  Texas Department of health officials disclosed that there were neither edits nor mechanisms within its fiscal agent's Medicaid Management Information System to detect and prevent this problem.  In addition to financial adjustments, we recommended the implementation of appropriate edits and other procedural corrections.