May 2021

April 2021

February 2021

Audit

Final Audit Report: Junior’s Pharmacy
The OIG Audit Division contracted Myers and Stauffer, LC to audit pharmacy claims to verify services provided to recipients, paid by Texas Medicaid. Issued February 3, 2021.

January 2021

Audit

Summary of Results: Pharmacy Benefits Manager Navitus Health Solutions, LLC
This report provides a summary and overview of the results and issues identified during audits of three managed care organizations that all subcontracted with Navitus as their pharmacy benefits manager. The audits, which were conducted in 2020, were of Community First Health Plans, Parkland Community Health Plan, and Community Health Choice. Published January 8, 2021.

December 2020

November 2020

Audit

Processing of Outlier Nursing Facility STAR+PLUS Claims and Adjustments: Superior HealthPlan
OIG conducted this audit as a follow-up to complaints of nursing facility payments being delayed by more than 90 days and of unprocessed retroactive adjustments. The audit objective was to determine whether Superior HealthPlan accurately and timely adjudicated qualified nursing facility provider clean claims in compliance with selected criteria. Issued November 20, 2020.

Audit

Homeward Bound, Inc.: Substance Use Disorder Treatment Provider
Homeward Bound ensured that clients met requirements to be eligible for its substance use disorder programs, including verifying that clients met financial requirements but should strengthen controls related to its HIV and residential detox programs. Issued November 13, 2020.

August 2020

Audit

Processing of Outlier Nursing Facility STAR+PLUS Claims and Adjustments: Amerigroup Texas
OIG conducted this audit as a follow-up to complaints of nursing facility payments being delayed by more than 90 days and of unprocessed retroactive adjustments. The audit objective was to determine whether Amerigroup accurately and timely adjudicated qualified nursing facility provider clean claims in compliance with selected criteria. Issued August 28, 2020.