Reports

The audit objective was to evaluate whether EduCare Community Living Corporation – Texas provided Medicaid beneficiaries living in three- and four-person residences with safe and healthy living environments, as defined by the HHSC Waiver Survey and Certification Residential Checklist and the COVID-19 emergency rules for the Home and Community-Based Services program. Issued October 15, 2021.

The audit objective was to determine whether documentation to support the authorization and delivery of durable medical equipment (DME) and supplies associated with Medicaid claims submitted by and paid to Cook Children’s Home Health by Cook Children’s Health Plan existed and was completed in accordance with applicable state laws, rules, and guidelines. Issued September 30, 2021.

The IG Quarterly Report for the fourth quarter of fiscal year 2021.

OIG evaluated whether Cenikor’s Region 6 residential withdrawal management and intensive residential treatment services (a) were provided in accordance with selected regulations and contractual requirements and (b) supported the payment received. Issued September 29, 2021.

The annual PARIS-VA Match Report for fiscal year 2021.

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.

The OIG Audit Division contracted Myers and Stauffer LC to audit whether behavioral health claims billed to, 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 31, 2021.

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.

The inspection focused on whether FRAC periodically verifies that DSP claims are valid and adequately supported, conducts retrospective reviews of DSP claims, and implemented policies and procedures to ensure delivery supplemental payment claims are processed timely and accurately. Issued August 31, 2021.

The inspection focused on mental health targeted case management and mental health rehabilitative services provided by local mental health authorities (LMHAs) and local behavioral health authority (LBHA) contracted providers. Issued August 30, 2021.

The OIG Audit Division contracted Myers and Stauffer LC to audit whether pharmacy claims billed to, 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 26, 2021.

The audit objective was to determine if Rebound performed co-treatment services, which occur when two or more therapy disciplines are performed concurrently, were billed correctly. Issued August 26, 2021.

The audit objective was to evaluate whether Community Options, Inc. provided Medicaid beneficiaries living in three- and four-person residences with safe and healthy living environments, as defined by the HHSC Waiver Survey and Certification Residential Checklist and the COVID-19 emergency rules for the Home and Community-Based Services program. Issued August 26, 2021.