Summary of Results: Psychiatric and Behavioral Health Teleservices in Texas Medicaid and CHIP Audits of Selected Texas Medicaid and CHIP Providers
Executive Summary - This report summarizes the results and conclusions of five audits conducted due to the increased risk associated with teleservice claims for evaluation and management, skills training, case management, and behavioral health services including psychiatry, psychotherapy, and occupational, physical and speech therapies caused by the increase in teleservices provided during the COVID-19 public health emergency. Issued November 21, 2024. OIG Report No. AUD-25-006.

Managed Care Pharmacy Benefit Services: Wellpoint Texas, Inc.; Wellpoint Insurance Company; CarelonRx Inc.; and CaremarkPCS Health, LLC
Executive Summary - The audit objective was to determine whether Wellpoint, CarelonRx, and Caremark had processes and controls in place to ensure payments and reimbursements for managed care pharmacy benefit services (a) were based on net reimbursements to pharmacies, (b) were accurately reported to the state of Texas, and (c) complied with the Uniform Managed Care Contract and other applicable requirements. Issued October 31, 2024. Report No. AUD-25-005 

Managed Care Pharmacy Benefit Services: Aetna Better Health of Texas Inc. and CaremarkPCS Health, LLC
Executive Summary - The audit objective was to determine whether Aetna and Caremark had processes and controls in place to ensure payments and reimbursements for managed care pharmacy benefit services (a) were based on net reimbursements to pharmacies, (b) were accurately reported to the state of Texas, and (c) complied with the Uniform Managed Care Contract and other applicable requirements. Issued October 31, 2024. Report No. AUD-25-004

EEG Services in Texas Medicaid: University of Texas Southwestern Medical Center
The audit objective was to determine whether claims submitted by UT Southwestern for ambulatory electroencephalogram (EEG) tests followed selected Texas Medicaid Provider Procedures Manual guidelines. Issued September 26, 2024. OIG Report No. AUD-25-002.

EEG Services in Texas Medicaid: Texas Children’s Physician Group
The audit objective was to determine whether claims submitted by Texas Children’s for ambulatory electroencephalogram (EEG) tests followed selected Texas Medicaid Provider Procedures Manual guidelines. Issued September 26, 2024. OIG Report No. AUD-25-003.

The Harris Center for Mental Health and Intellectual and Developmental Disabilities (IDD)
Executive Summary - The audit objective was to determine whether Harris Center (a) billed teleservices accurately and in accordance with applicable requirements and (b) designed and implemented related internal controls over teleservices. Issued September 3, 2024. OIG Report No. AUD-25-001.

Rolling Audit and Inspections Plan 2025
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.

National Seating & Mobility
The OIG Audit and Inspections Division contracted Myers and Stauffer LC to determine whether paid MCO DME 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 29, 2024. OIG Report No. AUD-24-032.

Bluebonnet Trails Community Services: A Local Mental Health Authority Contracted with the Texas Health and Human Services Commission
Executive Summary - The audit objective was to determine whether Bluebonnet Trails Community Services complied with selected state and contractual requirements. Issued August 29, 2024. OIG Report No. AUD-24-033.

Texana Center: A Local Mental Health Authority Contracted with the Texas Health and Human Services Commission
Executive Summary - The audit objective was to determine whether Texana Center complied with selected state and contractual requirements. Issued August 28, 2024. OIG Report No. AUD-24-031.

Managed Care Pharmacy Encounters Paid to Omnicare Pharmacy
Executive Summary - The audit objective was to determine whether Omnicare Pharmacy (a) properly dispensed prescriptions associated with selected encounters for Texas Medicaid members enrolled with Superior HealthPlan, Inc., UnitedHealthcare Community Plan of Texas, L.L.C., and UnitedHealthcare Insurance Company, Inc., and (b) complied with applicable contractual, state, and federal requirements. Issued August 28, 2024. OIG Report No. AUD-24-029.

Betty Hardwick Center: A Local Mental Health Authority Contracted with the Texas Health and Human Services Commission
Executive Summary - The audit objective was to determine whether Betty Hardwick Center complied with selected state and contractual requirements. Issued August 28, 2024. OIG Report No. AUD-24-030.

My Health My Resources Concho Valley: A Local Mental Health Authority Contracted with the Texas Health and Human Services Commission
Executive Summary - The audit objective was to determine whether My Health My Resources Concho Valley complied with selected state and contractual requirements. Issued August 27, 2024. OIG Report No. AUD-24-028.

Managed Care Pharmacy Encounters Paid to Meadowbrook Pharmacy
Executive Summary - The audit objective was to determine whether Meadowbrook Pharmacy (a) properly dispensed prescriptions associated with selected encounters for Texas Medicaid and CHIP members enrolled with Cook Children’s Health Plan, Wellpoint Texas, Inc., and Wellpoint Insurance Company and (b) complied with applicable contractual, state, and federal requirements. Issued August 23, 2024. OIG Report No. AUD-24-027.

Follow-Up Assessment on a Previously Published Audit Report — Cenikor Foundation: A Substance Use Disorder Treatment Provider in Region 7
The objective of the follow-up assessment was to determine the resolution status of OIG Audit’s previously identified issues at Cenikor, which included testing the effectiveness of management activities designed to remediate the identified issues. Issued August 22, 2024. OIG Report No. AUD-24-026.