Report Materials
Texas Medicaid did not always stop making capitation payments after a beneficiary's death, despite its efforts to identify and recover any unallowable payments. Specifically, Texas Medicaid paid managed care organizations $1.8 million ($1 million Federal share) for capitation payments between January 1, 2013, and December 31, 2015, for deceased beneficiaries.
18-A-06-020.01 to CMS - Closed Unimplemented
Closed on
05/29/2018
We recommend that Texas Medicaid identify and recover unallowable payments totaling $1,768,774 from MCOs and refund $1,038,875 (Federal share) to the Federal Government.
18-A-06-020.02 to CMS - Closed Unimplemented
Closed on
05/29/2018
We recommend that Texas Medicaid review capitation payments before and after our audit period for additional unallowable payments for these deceased beneficiaries.
18-A-06-020.03 to CMS - Closed Unimplemented
Closed on
05/29/2018
We recommend that Texas Medicaid work with SSA to determine whether the 77 beneficiaries whose status could not be verified are deceased and recover any unallowable payments.
18-A-06-020.04 to CMS - Closed Unimplemented
Closed on
05/29/2018
We recommend that Texas Medicaid strengthen its policies and procedures for identifying deceased beneficiaries and denying Medicaid benefits and ending eligibility to prevent future unallowable payments.
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Notice
This report may be subject to section 5274 of the National Defense Authorization Act Fiscal Year 2023, 117 Pub. L. 263.