Dental cases review offers insight in avoiding billing and compliance issues
Education and prevention are essential tools the OIG uses to avoid fraud, waste and abuse. To assist dental providers the agency is providing two case studies, one in record keeping and another in solicitation.
Featured News
Guard Your Card
The week before Thanksgiving is the busiest time of the year for American grocers, which means more opportunities for scammers.
Employee background check and training issues found during OIG inspection
A recent inspection by the OIG found that a North Texas nursing facility did not consistently comply with requirements for newly hired staff members.
Featured Reports
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
Quarterly Report: Quarter 4, FY 2024
The OIG published its fourth quarterly report for fiscal year 2024, summarizing the agency’s work and results achieved between June 1, 2024, and August 31, 2024.