Texas did not calculate or collect hospice cap overpayments totaling $10.5 million

Texas did not calculate or collect hospice cap overpayments totaling $10.5 million 
HHS-OIG; Report number: A-06-24-09001; Issued on 9/17/25, Posted on 9/22/5 

• Why OIG Did This Audit ...
• What OIG Found: Texas overpaid $10.5 million ($6.9 million Federal share) to 174 hospices (36 percent of hospices that received payments) for services provided during Federal fiscal years 2020 through 2022 because it did not have any policies and procedures related to calculating and collecting the hospice cap overpayments. Texas did not calculate these cap overpayments; therefore, it did not collect them or return the related Federal share.
• What OIG Recommends [the Texas]
1. collect the hospice cap overpayments totaling $10.5 million and refund the Federal share of $6.9 million to the Federal Government and
2. develop and implement policies and procedures related to calculating and collecting hospice cap overpayments. ...

Guest Editor's Note, Judi Lund Person: The Texas Health and Human Services Commission (HHSC) added the optional inpatient and aggregate caps to the Texas Medicaid Hospice benefit in 2011 and 2012, for patients receiving hospice services under Medicaid. . Many states have not adopted these optional caps on hospice services but it is important to check the Medicaid manual to ensure the status of these caps in your state.