Reports

September 2022

  • 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.

    Category: Audit
  • Executive Summary

    The audit objective was to determine whether Maximus accurately, timely, and in accordance with applicable requirements (a) communicated enrollment-related information to members who were determined eligible for Medicaid and CHIP services and (b) received and processed enrollment-related information from those members in state fiscal year 2021. Issued September 2, 2022. OIG Report No. AUD-23-001.

    Category: Audit

August 2022

  • The OIG Audit and Inspections Division contracted Weaver and Tidwell, L.L.P. to audit whether services billed and paid under the state Medicaid program were provided in accordance with applicable state and federal Medicaid laws, regulations, rules, policies, and contractual requirements. Issued August 31, 2022.

     

    Category: Audit
  • The OIG Audit and Inspections Division contracted Weaver and Tidwell, L.L.P. to audit whether services billed and paid under the state Medicaid program were provided in accordance with applicable state and federal Medicaid laws, regulations, rules, policies, and contractual requirements. Issued August 31, 2022.

    Category: Audit
  • The OIG Audit and Inspections Division contracted DK Partners to audit whether delivery of Durable Medical Equipment and submissions of Medicaid and CHIP managed care claims by One Source were in accordance with applicable Federal and State Medicaid laws, regulations, rules, policies, and contractual requirements.  Issued August 31, 2022.

    Category: Audit
  • The OIG Audit and Inspections Division contracted DK Partners to audit whether delivery of Durable Medical Equipment and submissions of Medicaid and CHIP managed care claims by Aeroflow were in accordance with applicable Federal and State Medicaid laws, regulations, rules, policies, and contractual requirements.  Issued August 30, 2022.

    Category: Audit
  • The OIG Audit and Inspections Division contracted Myers and Stauffer LC to audit whether pharmacy claims billed 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 29, 2022.

    Category: Audit
  • The OIG Audit and Inspections Division contracted Myers and Stauffer LC to audit whether pharmacy claims billed 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 29, 2022.

    Category: Audit
  • Executive Summary

    The audit objective was to determine whether Cypress Creek completed admission, commitment, and specific consent requirements for STAR+PLUS members receiving inpatient psychiatric services in accordance with selected federal and state regulations, rules, and policies. Issued August 25, 2022. OIG Report No. AUD-22-025.

    Category: Audit
  • The OIG Audit and Inspections Division contracted DK Partners to determine whether delivery of Durable Medical Equipment and submissions of Medicaid and CHIP managed care claims by Texas Home Modification Services were in accordance with applicable Federal and State Medicaid laws, regulations, rules, policies, and contractual requirements. Issued August 26, 2022.

    Category: Audit
  • Executive Summary

    The audit objective was to determine whether West Oaks completed admission, commitment, and specific consent requirements for STAR+PLUS members receiving inpatient psychiatric services in accordance with selected federal and state regulations, rules, and policies. Issued August 26, 2022. OIG Report No. AUD-22-026.

    Category: Audit
  • Executive Summary

    The audit objective was to determine whether (a) UnitedHealthcare reported expenses on selected components of its Medical and Combined financial statistical reports submitted to the Texas Health and Human Services Commission (HHSC) in accordance with contract requirements and laws and (b) the related internal controls over the preparation of the financial statistical reports were designed and operating effectively. Issued August 24, 2022. OIG Report No. AUD-22-024.

    Category: Audit
  • Executive Summary

    The audit objective was to determine whether American Medical Response ensured its contractor billed claims to managed care organizations in accordance with applicable statutes, rules, and procedures in the managed care environment. Issued August 18, 2022. OIG Report No. AUD-22-022.

    Category: Audit
  • Executive Summary

    The audit objective was to determine whether ReCept Pharmacy #1 (a) properly billed for paid claims associated with Medicaid and Children’s Health Insurance Program (CHIP) members enrolled with Aetna Better Health of Texas, Inc. and (b) complied with applicable contractual, state, and federal requirements. Issued August 22, 2022. OIG Report No. AUD-22-023.

    Category: Audit
  • The OIG Audit and Inspections Division contracted Myers and Stauffer LC to audit whether pharmacy claims billed 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 19, 2022.

    Category: Audit