HHS' Office of Inspector General found Texas received $18.9 million in Medicaid reimbursement for school-based health services that were "not reasonable, adequately supported and otherwise allowable."
OIG's 37-page audit concerns the School Health and Related Services program, which allows school districts to request Medicaid reimbursement for medically necessary health services to qualified disabled children.
OIG inspectors randomly reviewed Medicaid medical service costs claimed for SHARS between Oct. 1, 2010, and Sept. 30, 2011. During that time, Texas received $390 million in Medicaid reimbursement for services billed from 572 school districts.
The audit found 274 of 3,161 claims featured erroneous coding, resulting in $18.9 million in improper payment.
"These errors occurred because the state agency did not always follow its policies and procedures to ensure that the costs claimed for direct medical services were accurate and supported," the report states.
In May, OIG sent a draft of the audit to the Texas Health and Human Services Commission. In its response, the state department said the random sampling was "illustrative, not exhaustive and leaving room for interpretation and judgment," The Dallas Morning News reports.
The state health department said it would refund the government in a year when a final payment amount is determined.