OIG Data and Technology Team helps improve Medicaid policy

The OIG recommended a policy change to Texas Medicaid after our Data and Technology team found providers billing disproportionate amounts for urine drug tests (UDTs).

This was revealed through data mining, outlier detection and literature review. Providers were billing additional procedure codes for validity tests to verify that urine specimens were not tampered with; however, these validity tests are already included in the existing UDT procedure codes and should not be billed a second time.

Based on these findings, DAT made the following recommendations to Medicaid/CHIP Services (MCS):

• Define requirements for medical necessity of certain drug tests.
• Deny validity tests billed with UDTs on the same day, by the same provider.
• Exclude specific procedure codes related to UDTs billed on the same day by the same provider.

The above recommendations are another example of how the OIG continues to utilize sophisticated data analytics to help ensure the integrity of state health and human services. In response to the recommendation, MCS is revising Medicaid policy to clarify that documentation of medical necessity is required and is adding claims edits to prohibit inappropriate Medicaid reimbursement. MCS states the changes may take several months to implement.