November 18, 2019

The OIG completed an audit of the statewide financial impact of therapy practices at long-term care nursing facilities for fiscal year 2017.

The practice of clustering therapy sessions at the two nursing facilities increased the Resource Utilization Group (RUG) level assigned to associated residents and resulted in MCOs paying higher daily RUG reimbursements to the nursing facilities.

Audit results indicated that the practice of clustering therapy sessions allowed nursing facilities to bill MCOs an estimated $39.2 million more for resident daily care in 2017 than what would have been billed if the practice were prohibited by Texas Medicaid policy. Read the full audit for the details and potential impact of the OIG’s recommendations: https://tinyurl.com/y6ksxj3t