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January,
2002
 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
Summary of Findings
The TDH improperly
claimed FFP for clients between the ages of 21 to 64 who were
temporarily released from State hospitals, which the Texas
Department of Mental Health and Mental Retardation (MHMR)
identified as IMDs, to acute care hospitals for medical treatment.
The TDH officials
disclosed that there were neither edits nor mechanisms within
National Heritage Insurance Company's (NHIC) Medicaid
Management Information System (MMIS) to detect and prevent FFP
from being claimed for IMD clients between the ages of 21 to 64
who were temporarily released to acute care facilities for medical
care. The NHIC is the MMIS fiscal agent for the Medicaid program
and has administered the program since 1977.While MHMR had some
controls in place to preclude claiming FFP on behalf of 21 to 64
year old residents of IMDs, they were not always effective.
For the period September
1,1997 through August 31,2000,TDH improperly claimed FFP for
clients between the ages of 22 to 64 and for those aged 21 at
admission who were temporarily released from State hospitals to
general acute care hospitals for medical treatment.
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