Review of Medicaid Long-Term Care Payments for Individuals with Both Medicare and Medicaid Coverage

EXECUTIVE SUMMARY:

Based on a statistical sample, we estimated that the Texas Department of Human Services (Department) made incorrect Medicaid payments of at least $12,879 during the period January 1, 2001 through June 30, 2001 on behalf of dual eligible individuals which included payments for regular nursing and Medicare co-insurance.  Medicaid overpayments occurred because nursing facilities failed to send the appropriate Medicare skilled nursing facility (SNF) admission and discharge information to the Department.  We are recommending that the Department refund $7,801, which is the Federal share of our estimate of at least $12,879 in overpayment; strengthen controls concerning the accuracy of the SNF admission and discharge information; and work with the  Centers for Medicare and Medicaid Services to prevent incorrect payments.