In a recent audit, the OIG discovered that a dental management organization submitted financial statistical reports (FSRs) in fiscal years 2021 and 2022 that could erroneously increase the payment per client made by Texas Medicaid. FSRs, among other information, are used to determine if insurers are receiving sufficient payment to cover the cost of their client pool. This fixed per-client payment is known as a capitation rate.
UnitedHealthcare Dental reported expenses that were inaccurately calculated, unallowable or did not occur in that reporting period. Errors occurred in expense categories — including salaries, bonuses, legal costs, marketing and corporate allocations, among others — that resulted in an overstatement of $799,351.
Auditors also found that UnitedHealthcare Dental miscategorized more than $9million in expenses, such as labeling membership materials as marketing expenses. Additional errors that could impact the accuracy of capitation rates were found in pre-implementation, administrative and quality improvement expenses.
UnitedHealthcare Dental also failed to report fair market values for two affiliates that provided services during 2021. Reporting the $9,717 worth of expenses without the fair market value can result in the insurer overpaying and overstating expenses to the State of Texas.
Auditors made recommendations that, if followed, will bring UnitedHealthcare Dental into compliance with these concerns.