OIG audits financial impact of therapy practices

The OIG Audit Division has completed an audit of the statewide financial impact of therapy practices at long-term care nursing facilities.

The audit covered state fiscal year 2017 (Sept. 1, 2016-Aug. 31, 2017). The audit found that nursing facilities billed Texas Medicaid MCOs an estimated $39.2 million more for resident daily care in 2017, because of a practice known as clustering of therapy services, than nursing facilities would have billed MCOs if the practice was prohibited by Texas Medicaid policy.

This audit was conducted after previous OIG audits of two nursing facilities identified a practice of clustering therapy sessions during the Minimum Data Set assessment look-back period. 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.

You can read the full audit report here.