OIG updates audit and inspections plan for fiscal year 2024
The OIG has released potential audit and inspection topics for fiscal year 2024 following a risk assessment that identified programs, services, providers and contractors with an elevated potential for fraud. Topics are also considered for inclusion based on requests from the state legislature, executive management and public stakeholders before releasing an audit plan based on available resources and potential financial and client impacts.
For 2024, the Audit and Inspections Plan divides audit topics into four sections: Texas Health and Human Services (HHS) system audits, contractor audits, provider audits and information technology audits.
Texas Health and Human Services system audits review the effectiveness and efficiency of HHS Systems, including the operation and performance of individual programs. This fiscal year, HHS system topics may include:
- Clinical Management for Behavioral Health Systems data system.
- Comprehensive rehabilitation services.
- Daycare regulation.
- Texas Integrated Eligibility Redesign System data processing and integrity.
Contractor audits evaluate the performance of organizations accepting funds from HHS, verifies all requirements are met and that funds were used as intended. This fiscal year, contractor audit topics may include:
- Select contracts for the Department of Family and Protective Services, Department of State Health Services and
- Health and Human Services Commission.
- Managed care organization (MCO) reporting of provider refunds.
- MCO special investigative units (SIU).
- MCO subcontracted networks.
- Nursing facility outlier claims.
- Pharmacy benefits manager.
- STAR + PLUS waiver.
- Substance use disorder treatment facility.
Provider audits assess whether medical facilities companies and providers comply with statutes, rules, guidance or contracts regulating the provision of client care and applicable billing practices. This fiscal year, provider audit topics may include:
- Assisted living facilities.
- Centers for independent living.
- Consumer directed services.
- Durable medical equipment.
- Federally qualified health centers.
- Home and community-based services cost reporting.
- Nonemergency medical transport.
- Pediatric hospice services.
- Projects for assistance in transition from homelessness.
Information Technology audits assess the effectiveness of digital systems that support HHS programs, contractors or business partners who process and store information on behalf of the state. These audits also review whether these applications comply with contracted information security controls. This fiscal year, information technology audit topics will include:
- MCO information technology.
In addition to audits, the division will inspect HHS programs, contractors and providers based on current and emerging priorities. Multiple entities may be inspected for the same subject to provide adequate coverage of a specific topic. This fiscal year, inspection topics may include:
- MCO case-by-case reporting.
- MCO provider claims appeals.
- Nursing facility abuse, neglect and exploitation reporting.
- Nursing facility transfers to emergency rooms.
- Opioid prescribing practices.
- Trust funds in nursing facilities.
The OIG Audit and Inspection plan summarizes potential audits and inspections to be conducted throughout the fiscal year. However, as ongoing risk assessments reveal emerging topics, additional audits and inspections may occur.