August 2020

Audit

Processing of Outlier Nursing Facility STAR+PLUS Claims and Adjustments: Amerigroup Texas
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 Amerigroup accurately and timely adjudicated qualified nursing facility provider clean claims in compliance with selected criteria. Issued August 28, 2020.

Audit

Processing of Outlier Nursing Facility STAR+PLUS Claims and Adjustments: Cigna-HeathSpring
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 Cigna-HealthSpring accurately and timely adjudicated qualified nursing facility provider clean claims in compliance with selected criteria. Issued August 26, 2020.

Audit

Final Audit Report: Ennis Pharmacy
The OIG Audit Division contracted Myers and Stauffer, LC to audit pharmacy claims to verify services provided to recipients, paid by Texas Medicaid. Issued August 21, 2020.

Audit

Final Audit Report: Elgin Pharmacy
The OIG Audit Division contracted Myers and Stauffer, LC to audit pharmacy claims to verify services provided to recipients, paid by Texas Medicaid. Issued August 21, 2020.

Audit

Durable Medical Equipment Delivered to Deceased Beneficiaries: Nextra Health
This limited-scope audit explored the prevalence of DME services being provided after a Medicaid beneficiary’s death. For the deliveries tested, verification systems showed the beneficiary as eligible at the time of delivery. Therefore, this audit did not result in recommendations to Nextra. Issued August 20, 2020.

July 2020

June 2020