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Thursday, July 30, 2009

TMA MONITORING TEXAS MEDICAID MENTAL HEALTH RECOUPMENT ACTIONS

The Texas Health and Human Services Commission (HHSC) has begun sending letters to approximately 125 physicians and 75 hospitals to recover payments HHSC says were made erroneously for services provided to patients residing in Institutions of Mental Disease (IMDs). TMA’s Office of General Counsel and Division of Medical Economics have been researching the problem and are monitoring the recoupment activity. Under federal law, services provided to IMD residents between the ages of 21 and 64 are not eligible for federal matching Medicaid funding. HHSC is sending letters to physicians and hospitals seeking refunds of money paid for dates of service from 2001 to 2007. HHSC says no state law imposes a time limit on how far back the agency can reach for these recoupments. The letters say that the physician or hospital has 60 days to send a payment or proof of a prior refund. Actual recovery is scheduled to begin on Sept. 1. The amounts of the recoupment range from about $1,000 to $128,000. Physicians with financial hardships may ask the Texas Medicaid and Healthcare Partnership to consider repayment arrangements. According to HHSC, “the provider is required to submit financials to establish the need and the terms of the repayment.”

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