Reports

Executive Summary

The audit objective was to determine whether Sherry Matthews Group delivered and billed for selected services in compliance with applicable contract requirements. Issued March 31, 2023. OIG Report No. AUD-23-006.

Executive Summary

The audit objective was to determine whether Blue Cross and Blue Shield of Texas conducted oversight activities to ensure its durable medical equipment claims were reimbursed in accordance with selected applicable contractual requirements, federal and state laws, rules, guidelines, and policies. Issued March 23, 2023. OIG Report No. AUD-23-005.

Executive Summary

This audit was to determine whether Boysville had processes and controls in place to ensure it provided foster care services at Thompson Emergency Shelter in accordance with selected statutes, contract terms, and minimum standards. Issued February 28, 2023. OIG Report No. AUD-23-004.

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.

Executive Summary

This report summarizes audits published between 2018 and 2022 of special investigative unit activities at five managed care organizations: Aetna Better Health of Texas, Blue Cross and Blue Shield of Texas, Community First Health Plans, Driscoll Health Plan, and Molina Healthcare of Texas. Issued November 28, 2022. OIG Report No. AUD-23-003.       

Executive Summary

The audit objective was to determine whether the Texas Health and Human Services Commission (HHSC) Home and Community-Based Services (HCS) program’s (a) residential reviews aligned with certification requirements and enforcement remedies, (b) residential reviewers used the HHSC Waiver Survey and Certification Residential Checklist correctly and consistently, and (c) residential review results were maintained and analyzed. Issued November 22, 2022. OIG Report No. AUD-23-002.

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.

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.

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.

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.

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.

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.

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.

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.

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.