Texas HHSC Failing at Medicaid Fraud Prevention
- Last week, the Texas Sunset Advisory Commission issued a less than positive report of the Texas Health and Human Services Commission (HHSC). The main takeaway is that the organization needs to undergo a massive overhaul of its operations to be successful.
The committee was created in 2003 by House Bill 2292 and consolidated 12 agencies into five. The goal was to consolidate functions to save money and improve services by eliminating fragmentation. However, after 11 years, it appears that the agency is far from being complete and needs significant changes to make the concept actually work.
“The problem is with the nature of the system itself, and the incompleteness of its set up,” the report states. “The problem is that for whatever reason, the state did not finish the job. That is not to cast aspersions on the herculean effort required to set up the system in the midst of so many other changes back in 2003. Instead, that assessment should serve as a challenge to recognize this opportunity to take a big step toward completing the envisioned consolidation.”
The Sunset Commission detailed 15 systemic issues with the health commission and offered recommendations for retooling the state’s health services including consolidating down to a single agency. It found that the HHSC’s Office of Inspector General conducts virtually no prevention efforts, takes an average of more than three years to resolve cases of alleged fraud, abuse or waste and wins back only a fraction of the amount of inappropriate spending it finds.
For example in the fiscal years 2012 and 2013, OIG investigators identified more than $1.1 billion worth of potential Medicaid overbilling by providers but only collected $5.5 million. Furthermore, auditors believe the program has been overzealous about the use of federal law allowing it to freeze Medicaid payments of suspected fraudsters which has forced some providers out of business.
“The problems identified in this report are unacceptable and need to be addressed,” state Sen. Jane Nelson, R-Flower Mound, chairwoman of the Sunset Commission, told the Houston Chronicle. “We will get to the bottom of this issue, but we have a lot more digging to do.”
The Health Commission did respond to the harsh report. Executive Commissioner Kyle Janek released a statement saying he appreciates the Sunset Commission’s vision of a system that will better serve its clients and will take .
“Whatever the Legislature ultimately decides, we’ll be ready to quickly put in place the changes they approve to improve our programs and ensure we operate as efficiently as possible,” Janek said.
He added that the organization will hire a special assistant that will be in place by November 1, 2014. Their job will be to “make sure policies and processes are fair and effective and clearly communicated to providers.”
