Medicare Compliance & Reimbursement
OIG, LONE STAR STATE SPAR OVER DSH
Texas hospitals that serve significant numbers of low-income and uninsured patients would likely face Medicaid reimbursement shortfalls if the state’s health department heeds recent counsel from the HHS Office of Inspector General. But it appears the Lone Star State is sticking to its guns in the way it handles disproportionate share hospital payments.
DSH payments are designed to provide added reimbursement to hospitals that provide care to a disproportionate share of low-income patients with special needs. In an audit report released
March 10, the OIG says Texas’ Medicaid program overpaid hospitals more than half a billion dollars between 1996 and 1998 because it didn’t have controls in place to assure that payments didn’t exceed the actual costs of the services provided.
The state’s health agency, however, counters that it made disproportionate share hospital payments prospectively, based on a plan that was approved by the Centers for Medicare & Medicaid Services, and that there simply is no statutory requirement to retrospectively balance DSH payments against actual costs.
The OIG’s report is titled “Audit of Texas Medicaid Inpatient Disproportionate Share Hospital Program for Hospital Fiscal Years 1996 through 1998” (A-06-01-00041). To see it, go to http://oig.hhs.gov/oas/reports/region6/60100041.pdf.
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