Medicare Compliance & Reimbursement

Ongoing OIG probe addresses Medicaid payments for IMD residents.

In its latest attempt to assess whether states are blocking federal payments for most residents of institutions for mental diseases - as they're required to do under a longstanding, if oft-misunderstood, federal policy - the HHS Office of Inspector General casts its sights on the Virginia and Texas health departments. The results: neither state has the controls in place to keep from billing the feds for care the states are supposed to foot the bill for themselves. The ongoing, nationwide series of reviews is designed to ensure that states aren't claiming federal financial participation under the Medicaid program for IMD residents between the ages of 21 and 64 - a class of patients for which federal payments aren't available. In the latest reports, the OIG says Virginia owes the federal government more than $125,000 while Texas has to pony up nearly $1.3 million.  Texas says it plans to recoup the money from providers - but the OIG points out that its review involved improper FFP claims from the state, not inappropriate payments to providers. The reports are titled "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" (A-06-03-00009) and "Review Of Medicaid Claims Made For 21 To 64 Year Old Residents Of Private Institutions For Mental Diseases In The Commonwealth Of Virginia" (A-03-02-00206). To see the Texas report, go to http://oig.hhs.gov/oas/reports/region6/60300009.pdf. To see the Virginia report, go to http://oig.hhs.gov/oas/reports/region3/30200206.pdf. Lesson Learned: Health care providers in Texas may see Medicaid overpayment demands for claims connected with IMD residents.