Reports

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.

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.

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.

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.

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.

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.

Executive Summary

The audit objective was to determine whether (a) Molina Healthcare of Texas, Inc. reported expenses on its 334-day 2020 Combined Administrative and Quality Improvement Expenses financial statistical report submitted to the Texas Health and Human Services Commission in accordance with contract requirements and laws and (b) the related internal controls over the preparation of the financial statistical report were designed and operating effectively. Issued August 16, 2022. OIG Report No. AUD-22-021.

Executive Summary

The audit objective was to evaluate whether Elara Caring (a) developed and performed individualized service plans, (b) performed visit maintenance for selected EVV transactions in accordance with selected regulations, and (c) performed selected oversight activities. Issued August 12, 2022. OIG Report No. AUD-22-019

Executive Summary

The audit objective was to evaluate whether Girling (a) developed and performed individualized service plans, (b) performed visit maintenance for selected EVV transactions in accordance with selected regulations, and (c) performed selected oversight activities. Issued August 12, 2022. OIG Report No. AUD-22-020

Executive Summary

The audit objective was to determine whether the City of Houston Health Department had processes and controls in place to ensure it administered the STD/HIV Prevention Services Grant Program in accordance with selected grant agreement requirements for performance, data management, reporting, and grant expenditures. Issued August 11, 2022. OIG Report No. AUD-22-018.

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 July 25, 2022.

Executive Summary

The audit objective was to determine whether Dallas County Health and Human Services had processes and controls in place to ensure it administered the STD/HIV Prevention Services Grant Program in accordance with selected grant agreement requirements for performance, data management, reporting, and grant expenditures. Issued August 2, 2022. OIG Report No. AUD-22-017.

The audit assessed the design and effectiveness of selected security controls over confidential HHS System information stored and processed by Scott and White Health Plan. Issued July 22, 2022. OIG Report No. AUD-22-015.

Executive Summary 

OIG evaluated whether Matagorda House, advertising as a memory care facility, provided services delivered and operated in compliance with applicable laws, rules, and guidelines. Issued July 22, 2022. OIG Report No. AUD-22-016.
 

Executive Summary

The audit objective was to determine whether the San Antonio Metropolitan Health District had processes and controls in place to ensure it administered the STD/HIV Prevention Services Grant Program in accordance with selected grant agreement requirements for performance, data management, reporting, and grant expenditures. Issued July 15, 2022. OIG Report No. AUD-22-014.