September 2021
August 2021
Delivery Supplemental Payments (DSP): Medicaid CHIP Services—Financial Reporting and Audit Coordination (FRAC)
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.
Audit of Vida Clinic
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.
Mental Health Targeted Case Management and Mental Health Rehabilitative Services in Managed Care: Local Mental Health Authorities and Local Behavioral Health Authorities in Texas Medicaid
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.
Health and Safety of Medicaid Beneficiaries in the HHSC Home and Community-Based Services Program: Community Options, Inc.
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.
Avita Pharmacy
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.
Cenikor Foundation: Region 11 Substance Use Disorder Treatment Provider
OIG evaluated whether Cenikor’s Region 11 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 August 26, 2021.
Co-Treatment Therapy Billing: Rebound Sports and Physical Therapy
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.
Angleton Health Mart Pharmacy
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 25, 2021.
Supplemental Nutrition Assistance Program: Second Level Review Process
This inspection determined the second level review process is operating effectively to detect errors and prevent distribution of ineligible SNAP benefits. As a result, no observations were identified for this inspection. Issued August 25, 2021.
Health and Safety of Medicaid Beneficiaries in the HHSC Home and Community-Based Services Program: Kenmar Residential HCS Services, Inc.
The audit objective was to evaluate whether Kenmar Residential HCS Services, 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 23, 2021.
NorthgateArinso, Inc: A Texas Health and Human Services Commission Contractor
The audit objectives were to determine whether (a) the Retrospective Cost Settlement statements for the unaudited periods of the original contract, as amended, with HHSC, contract years 2019 and 2020, were reasonably stated and (b) NorthgateArinso, Inc. was in compliance with a selected renewal contract requirement for information security. Issued August 20, 2021.
Aetna Better Health of Texas: Special Investigative Unit
The audit evaluated Aetna’s policies and practices associated with preventing, detecting, investigating, and reporting fraud, waste and abuse. Issued August 18, 2021.
Cenikor Foundation: Region 4 Substance Use Disorder Treatment Provider
OIG evaluated whether Cenikor’s Region 4 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 August 13, 2021.
Managed Care Pharmacy Claims Paid to Rx Plus Pharmacy of Live Oak: A Managed Care Network Provider Contracted Under Superior HealthPlan, Inc.
The audit objectives were to determine whether Rx Plus Pharmacy of Live Oak (a) properly billed for paid claims associated with Medicaid members enrolled with Superior HealthPlan, Inc. and (b) complied with applicable contractual, state, and federal requirements. Issued August 13, 2021.