Instead, BSA typically notifies NHIC to recover improper payments or explain proper billing practices to a noncompliant provider. The agency's Vendor Drug Program oversees the delivery of outpatient prescription drugs under the Medicaid program. Vendor Drug reviews these claims to see if prescriptions are appropriate and billed legitimately. Through regional pharmacists, the program performs on-site and desk reviews of all 3,500 contracted pharmacists in Texas to ensure they comply with Medicaid requirements. Vendor Drug also processes all Medicaid payments for outpatient pharmaceutical claims.
Little deterrent exists, therefore, for pharmacies to avoid such practices.
Vendor Drug employs 82 FTEs, including 28 regional pharmacists. The division reviews the overall quality of care and relevant records to determine if hospital stays were appropriate and medical treatments were necessary. UAR occasionally helps Sanctions and MFCU in their investigations, spending about 10 percent of its annual budget for this purpose. National Heritage Insurance Corporation NHIC, Texas' Medicaid contractor, processes all Medicaid claims through its computerized Surveillance Utilization Review Subsystem, which weighs each provider's claims against those of his or her peers. Sanctions requires NHIC to forward lists of providers whose claims history deviates substantially from their peers to Sanctions for investigation.