First Quarterly Report of fiscal year 2025 released
The Office of Inspector General published its first quarterly report for fiscal year 2025, with performance metrics, case summaries and agency highlights.
Featured News
Fort Worth pharmacy overpaid for some Medicaid client prescriptions
A recent audit conducted by the OIG found a pharmacy was overpaid for prescriptions dispensed to Texas Medicaid and Children’s Health Insurance Program (CHIP) members.
Pharmacy benefit manager uses unallowable pricing model
Despite being refused access to necessary records, OIG auditors uncovered evidence that a pharmacy benefit manager used an unallowable pricing model that resulted in spread pricing.
Featured Reports
Quarterly Report: Quarter 1, FY 2025
The OIG published its first quarterly report for fiscal year 2025, summarizing the agency’s work and results achieved between September 1, 2024, and November 30, 2024.
Managed Care Pharmacy Benefit Services: Aetna Better Health of Texas Inc. and CaremarkPCS Health, LLC
Executive Summary - The audit objective was to determine whether Aetna and Caremark had processes and controls in place to ensure payments and reimbursements for managed care pharmacy benefit services (a) were based on net reimbursements to pharmacies, (b) were accurately reported to the state of Texas, and (c) complied with the Uniform Managed Care Contract and other applicable requirements. Issued October 31, 2024. Report No. AUD-25-004
Managed Care Pharmacy Benefit Services: Wellpoint Texas, Inc.; Wellpoint Insurance Company; CarelonRx Inc.; and CaremarkPCS Health, LLC
Executive Summary - The audit objective was to determine whether Wellpoint, CarelonRx, and Caremark had processes and controls in place to ensure payments and reimbursements for managed care pharmacy benefit services (a) were based on net reimbursements to pharmacies, (b) were accurately reported to the state of Texas, and (c) complied with the Uniform Managed Care Contract and other applicable requirements. Issued October 31, 2024. Report No. AUD-25-005