Multiple Identification Numbers in Texas Medicaid and CHIP
Learn how the AI-generated research projects were createdOverall Conclusion
AES had processes and controls to prevent and detect the creation of multiple IDs and associated overpayments, but improvements can be made to further limit the creation of multiple IDs for Texas Medicaid and CHIP members.
Source Document
Audit Scope
May 1, 2024 through April 30, 2025; scope includes AES's management of Texas Medicaid and CHIP IDs and merges within TIERS and related overpayments, limited to members enrolled in the STAR program.
Key Findings Summary
AES continued to create multiple IDs for the same individual, resulting in estimated overpayments of $235,642.66 for 119 members identified May 2024–April 2025, and challenges locating existing IDs when biographical information is incorrect.
AI-Assisted
AI Scope Summary
This audit examined whether AES had processes to prevent and detect the creation of multiple IDs and overpayments for Texas Medicaid and CHIP members during May 1, 2024, to April 30, 2025. Although AES had some controls, the period included 239 IDs assigned to 119 members, with estimated overpayments of $235,642.66. Not all merges were completed and some overpayment referrals were missing, indicating areas for strengthening TIERS ID management, merges, and overpayment referrals in future audits.
AI-Generated Insight
The inspection confirms that while AES has prevention and detection measures for multiple IDs, significant enhancements are needed in tie-ins with TIERS, merge completion, and reporting to recover overpayments; future audits should emphasize the robustness of merges and referral processes.
Audit Objectives
Determine whether AES had processes and controls to prevent and detect the creation of multiple IDs and associated overpayments for Texas Medicaid and CHIP members.
Audit Findings (1)
AES continued to create multiple IDs for the same individual, resulting in estimated overpayments of $235,642.66 for 119 members identified May 2024–April 2025, and challenges locating existing IDs when biographical information is incorrect.
Recommendations (5)
Compare available information in TIERS on every new application to determine whether an ID already exists and utilize the original ID before approving an applicant.
Review any remaining uncorrected IDs created for the individuals identified in this inspection, merge IDs as applicable, and recover associated overpayments.
Train Data Integrity division staff members to correctly process all required merges, identify overlapping benefit months, and create overpayment referrals.
Update procedures to document the Data Integrity division's secondary review process to verify staff correctly complete all required merges and create overpayment referrals as required.
File an overpayment referral with the OIG for the 42 merges identified with missing overpayment referrals.