Review of Texas Medicaid Claims for 21 to 64 Year Old Residents of Institutions for Mental Diseases Who Were Temporarily Released to Acute Care Hospitals

This final report points out that, for the period September 1, 1997 through August 31, 2000, the State Agency improperly claimed FFP of $424,838 for institutions for mental disease residents between the ages of 21 to 64 who were temporarily released from State hospitals to general acute care hospitals for medical treatment.  We recommended that the State Agency:   (1) refund $424,838 to the Federal Government for FFP improperly claimed; (2) cease claiming FFP for clients between the ages of 22 to 64 and those aged 21 at admission when these clients are temporarily released from State hospitals to general acute care hospitals for medical treatment; and (3) develop controls or edits within its Medicaid Management Information System to detect and prevent claims for FFP for clients between the ages of 22 to 64 and for those aged 21 at admission who are temporarily released from State hospitals to general acute care hospitals for medical treatment.  The State Agency agreed with our recommendations.