OIG finds incorrectly reported encounter data

The results of an OIG audit found that a Texas Medicaid and Children’s Health Insurance Program (CHIP) managed care organization (MCO) incorrectly reported encounter data. Encounter data are detailed records an MCO submits to Texas Health and Human Services (HHS) about services delivered to its managed care members by network providers.

Incorrectly reported encounter data is a contract and program violation, which causes these transactions to be misclassified between line items in HHS financial reports. The MCO acknowledged the coding was incorrect and initiated a project to correct encounter data. HHSC Medicaid and CHIP Services, through its contract oversight responsibility, will monitor the MCO to ensure corrective actions are in place to strengthen its current and future encounter data reporting.

You can read the complete audit at https://tinyurl.com/OIGencounterdata