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.
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.
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.
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.
Medicaid clients and providers are a critical link in combating Medicaid fraud
Fraud Awareness Week reminds us that protecting program integrity in Medicaid requires everyone’s assistance. Clients, providers, insurers and government agencies must all work together to protect the state’s health
Pharmacy Benefit Manager uses prohibited payment and reimbursement processes
The OIG released a recent audit that showed a pharmacy benefit manager had inappropriately combined multiple components paid t
Follow-up assessment of a previously audited provider finds issues remain
A recent follow-up audit on a central Texas substance use disorder treatment service found the provider had not fully addressed three of four previously noted issues.
Audit shows lab did not receive prior approval for exceeding tested allergen limits
An OIG audit found improper billing for allergy tests, which exceeded the 30-allergen limit. The lab failed to get prior authorization for the additional allergen testing, which resulted in incorrect billing and rei