Reports

The IG Quarterly Report for the fourth quarter of fiscal year 2023.

The Consolidated Senate Bill 30 Annual Report for fiscal year 2023.

Final audit reports are posted to the OIG website when issued. These reports are subject to appeal upon timely, written, proper requests for appeal, as provided for in rule. These final audit reports are public records and remain posted on the website during and after an appeal.

Executive Summary

The audit objective was to determine whether Bemaj Pharmacy, Inc. (a) properly billed for selected paid encounters associated with Texas Medicaid members enrolled with Amerigroup and Superior and (b) complied with applicable contractual, state, and federal requirements. Issued September 1, 2023. OIG Report No. AUD-24-001.

Executive Summary

The inspection objective was to determine whether Community First Health Plans has processes and controls to ensure non-medically necessary ambulance claims are denied in compliance with applicable requirements. Issued August 31, 2023. OIG Report No. INS-23-012.

The OIG has updated its Rolling Audit and Inspections Plan, which outlines potential audit and inspections areas and topics.

The OIG Audit and Inspections Division conducts a continuous risk assessment to identify potential topics for inclusion in its Rolling Audit and Inspections Plan. Potential audit and inspections topics consist of programs, services, providers and contractors with an elevated potential for fraud, waste and abuse.

Executive Summary

The OIG conducted an audit to determine whether The Bridge Over Troubled Waters, a Family Violence Program contractor, had financial processes and controls in place to ensure grant expenditures were accurate, allowable, and supported. Issued August 30, 2023. OIG Report No. AUD-23-035

The OIG Audit and Inspections Division contracted Weaver and Tidwell to determine whether telemedicine services billed and paid under the state Medicaid program were provided in accordance with applicable state and federal Medicaid laws, regulations, rules, policies, and contractual requirements. Issued August 31, 2023. OIG Report No. AUD-23-036.

The OIG Audit and Inspections Division contracted Weaver and Tidwell to determine whether telemedicine services billed and paid under the state Medicaid program were provided in accordance with applicable state and federal Medicaid laws, regulations, rules, policies, and contractual requirements. Issued August 29, 2023. OIG Report No. AUD-23-034.

Executive Summary

The inspection objective was to determine whether Driscoll has processes and controls to ensure non-medically necessary ambulance claims are denied in compliance with applicable requirements. Issued August 29, 2023. OIG Report No. INS-23-011.

The OIG Audit and Inspections Division contracted Weaver and Tidwell to determine whether telemedicine services billed and paid under the state Medicaid program were provided in accordance with applicable state and federal Medicaid laws, regulations, rules, policies, and contractual requirements. Issued August 24, 2023. OIG Report No. AUD-23-033.

Executive Summary

The OIG evaluated whether Driscoll complied with selected state and contractual requirements related to (a) preventing, detecting, and investigating fraud, waste and abuse and (b) reporting reliable information on SIU activities, results and recoveries to the OIG. Issued August 23, 2023. OIG Report No. AUD-23-032.

The OIG Audit and Inspections Division contracted Myers and Stauffer LC to determine whether pharmacy claims billed and paid under the state Medicaid program were in accordance with applicable state and federal Medicaid laws, regulations, rules, policies, and contractual requirements. Issued August 23, 2023. OIG Report No. AUD-23-031.

Executive Summary

The audit objective was to determine whether the Texas Department of State Health Services (DSHS), through certain contracting and program management functions, effectively managed the STD/HIV Prevention Services Program. Issued August 22, 2023. OIG Report No. AUD-23-030.

Executive Summary

The audit objective was to determine whether Lauve’s Pediatric Extended Care (Lauve's Pediatric) provided services in accordance with selected rules, statutes, and requirements. Issued August 22, 2023. OIG Report No. AUD-23-029.