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.

Summary of Results: Psychiatric and Behavioral Health Teleservices in Texas Medicaid and CHIP Audits of Selected Texas Medicaid and CHIP Providers
Executive Summary - This report summarizes the results and conclusions of five audits conducted due to the increased risk associated with teleservice claims for evaluation and management, skills training, case management, and behavioral health services including psychiatry, psychotherapy, and occupational, physical and speech therapies caused by the increase in teleservices provided during the COVID-19 public health emergency. Issued November 21, 2024. OIG Report No. AUD-25-006.

MCO Provider Claims Appeals: FirstCare Health Plans
Executive Summary - The OIG conducted this inspection to determine whether FirstCare tracks, resolves, and reports provider claims appeals as required. Issued November 21, 2024. Report No. INS-25-004

Case-by-Case Services: Parkland Community Health Plan
Executive Summary - The OIG conducted this inspection to determine whether Parkland Community Health Plan reported case-by-case services in accordance with applicable requirements. Issued November 4, 2024. OIG Report No. INS-25-003

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 

Nursing Facility Abuse, Neglect, Exploitation, and Misappropriation: Midtowne Meadows Health and Rehab
Executive Summary - The inspection objective was to determine whether Midtowne Meadows has processes and procedures to document and report abuse, neglect, exploitation, and misappropriation incidents as required by state law. Issued October 28, 2024. Report No. INS-25-002

State Hospital Investigations Report FY 2024
The Annual Report of State Hospital Investigations for fiscal year 2024.

State Supported Living Center Investigations Report FY 2024
The Annual Report of State Supported Living Center Investigations for fiscal year 2024.

Case-by-Case Services: Superior HealthPlan, Inc., and Superior HealthPlan Network
Executive Summary - The OIG conducted this inspection to determine whether Superior HealthPlan reported case-by-case services in accordance with applicable requirements. Issued October 22, 2024. OIG Report No. INS-25-001

Consolidated SB 30 Report
The Consolidated Senate Bill 30 Annual Report for fiscal year 2024.

PARIS-VA Match Report
The annual PARIS-VA Match Report for fiscal year 2024.

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.

EEG Services in Texas Medicaid: University of Texas Southwestern Medical Center
The audit objective was to determine whether claims submitted by UT Southwestern for ambulatory electroencephalogram (EEG) tests followed selected Texas Medicaid Provider Procedures Manual guidelines. Issued September 26, 2024. OIG Report No. AUD-25-002.

EEG Services in Texas Medicaid: Texas Children’s Physician Group
The audit objective was to determine whether claims submitted by Texas Children’s for ambulatory electroencephalogram (EEG) tests followed selected Texas Medicaid Provider Procedures Manual guidelines. Issued September 26, 2024. OIG Report No. AUD-25-003.