Texas Generally Claimed Medicaid Reimbursement for Fee-for-Service Inpatient Hospital Claims With Malnutrition Diagnosis Codes in Accordance with Federal and State Requirements

Why OIG Did This Audit

• A previous OIG audit found that hospitals nationwide had incorrectly billed the Medicare program by using severe malnutrition diagnosis codes when they should have used codes for other forms of malnutrition or used no malnutrition diagnosis code at all.
• Incorrectly using malnutrition diagnosis codes can result in a higher payment for the claim.
• This audit assessed Medicaid fee-for-service (FFS) inpatient hospital claims with malnutrition diagnosis codes to determine whether Texas claimed reimbursement in accordance with Federal and State requirements.

What OIG Found

Texas claimed reimbursement in accordance with Federal and State requirements for 88 of 100 sampled FFS inpatient hospital claims with malnutrition diagnosis codes. However, the remaining 12 sampled claims did not comply with Federal and State requirements.

• For 10 sampled claims, the associated medical record documentation did not support the malnutrition diagnosis code; however, the use of the diagnosis code did not impact the Medicaid payment amount.
• For two sampled claims, the State agency improperly claimed $9,213 ($5,478 Federal share).

What OIG Recommends

This report does not contain recommendations.

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