December 2020

Other

Value-Based Purchasing Program Integrity Considerations
Value-based purchasing (VBP) models are utilized in government health insurance programs to shift payments from volume to value. This informational report explores how VBP has evolved nationally, Texas’ implementation and a discussion of potential program integrity challenges and considerations related to the OIG’s future work in this space. Issued December 21, 2020. Summary version.

Other

Joint OIG-MFCU Report
The Joint Annual Report on Fraud and Abuse in Medicaid, compiled by OIG and the Attorney General's Medicaid Fraud Control Unit, for fiscal year 2020.

November 2020

Audit

Processing of Outlier Nursing Facility STAR+PLUS Claims and Adjustments: Superior HealthPlan
OIG conducted this audit as a follow-up to complaints of nursing facility payments being delayed by more than 90 days and of unprocessed retroactive adjustments. The audit objective was to determine whether Superior HealthPlan accurately and timely adjudicated qualified nursing facility provider clean claims in compliance with selected criteria. Issued November 20, 2020.

Audit

Homeward Bound, Inc.: Substance Use Disorder Treatment Provider
Homeward Bound ensured that clients met requirements to be eligible for its substance use disorder programs, including verifying that clients met financial requirements but should strengthen controls related to its HIV and residential detox programs. Issued November 13, 2020.

September 2020