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Wednesday, October 8, 2014

SUNSET REPORT CALLS OUT MEDICAID FRAUD CONTROL TACTIC


The state’s use of freezing payments to providers suspected of possible Medicaid fraud “has gone beyond the law’s intent,” according to a 225-page report on the Texas Health and Human Services Commission (HHSC) issued late Friday by the Texas Sunset Advisory Commission. The report includes sweeping recommendations for the vast agency, including further consolidation of the state’s health activities. The Sunset Commission described the HHSC Office of Inspector General (OIG) as an agency with poorly trained staff and little accountability or transparency. Sunset devoted an entire chapter of its report to OIG’s improper use of payment holds. “Despite the intended serious nature of payment holds, OIG uses payment holds as a negotiation tactic or bargaining tool, even for cases that do not pose significant financial risks to the state,” Sunset reported. “[Payment hold] hearings provide for excessive process and create undue burdens on providers as compared to cases presenting more serious risks to the state and public.” Sunset Commission recommendations serve as a starting point for deliberations by the 2015 legislature.

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