August 2022

Audit

One Source Medical Group
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.

Audit

Heart of Texas Region MHMR Center n/k/a Heart of Texas Behavioral Health Network
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.

 

Audit

Aeroflow Inc.
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.

Audit

Y Medical Associates, Inc.
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.

Audit

Southside Pharmacy 9
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.

Audit

Texas Home Modification Services
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.

Audit

Inpatient Psychiatric Hospitals: West Oaks Hospital
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.

Audit

Inpatient Psychiatric Hospitals: Cypress Creek Hospital
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.

Audit

Administrative and Medical Expenses Reported on Financial Statistical Reports: UnitedHealthcare Community Plan of Texas, L.L.C. and UnitedHealthcare Insurance Company, Inc.
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.

Audit

Amber Pharmacy
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.

Audit

Managed Care Pharmacy Claims Paid to ReCept Pharmacy #1: A Managed Care Network Provider Contracted Under Aetna Better Health of Texas, Inc.
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.

Audit

Acorn Pharmacy
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.

Audit

Administrative Expenses Reported by Molina Healthcare of Texas, Inc. on Its Financial Statistical Report
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.