March 7, 2003
The Honorable Rick Perry
The Honorable David Dewhurst
The Honorable Tom Craddick
Members of the 78th Legislature
I am pleased to deliver the Texas Health Care Claims Study pursuant to my obligation under Government Code Section 403.028. This study measured the incidence of potential overpayments in the Medicaid Fee-for-Service program, the Medicaid Vendor Drug Program, and the state employees workers’ compensation program administered by the State Office of Risk Management. This study was conducted in consultation with the State Auditor’s Office and with the cooperation of many state agencies.
The study found that 13.5 percent of the paid amount of services were potentially overpaid in the Medicaid Fee-for-Service sample, 20.5 percent were potentially overpaid in the Vendor Drug Program pilot sample, and 19.9 percent were potentially overpaid in the state employees workers’ compensation sample. Annually, these potential overpayments could be as much as $446 million in the Medicaid Fee-for-Service program, $287 million in the Medicaid Vendor Drug program, and $8 million in the state employees workers’ compensation program.
The January 2001 Texas Health Care Claims Study found potential overpayment percentages of 7.2 percent for the Medicaid Fee-for-Service program and 8.1 percent for the state employees workers’ compensation program. There is a significant increase in the overpayment rates between the 2001 and 2003 Medicaid Fee-for-Service findings that is analyzed in the study. The increase in the state employees workers’ compensation program is due to the addition of a medical record review for the 2003 study.
The study provides updates on the affected agencies’ progress with the January 2001 technical recommendations to improve their payment processes and new recommendations from this study.
This report is available on my Website at www.window.state.tx.us/specialrpt/hcc2003/. If you have any questions about this report, please contact Cindy Wiley, of my Research and Policy Development Division, by e-mail at email@example.com or by phone at 475-0155.
Please let me know if I can ever be of assistance. Thanks for all that you do for Texas.
Carole Keeton Strayhorn