Reports

OIG conducted this audit to ensure co-treatment services, which occur when two or more therapy disciplines are performed concurrently, were billed correctly. The audit found no instances of co-treatment and made no findings. Issued June 22, 2021.

OIG conducted a series of audits in 2020 of State of Texas Access Reform PLUS (STAR+PLUS) nursing facility claims paid by the five Texas managed care organizations (MCOs) that participate in the STAR+PLUS program. This summary report details issues found across all five audits and the MCOs’ progress since they were published. Published May 28, 2021.

The audit objective was to determine whether Superior had controls in place to ensure its payments to its subcontracted PBM (a) were based on actual amounts paid to pharmacies, (b) were accurately reported to the state, and (c) complied with other applicable requirements related to spread pricing. Published May 28, 2021.

The audit objective was to determine whether Driscoll accurately reported selected administrative expenses to HHSC, including a review of internal controls related to developing the Administrative Expenses Financial Statistical Report. Published May 27, 2021.

OIG conducted an audit of select long-term care eligibility processes at the Texas Medicaid and Healthcare Partnership (TMHP) for new members enrolling in the Medically Dependent Children Program. This audit did not result in recommendations to TMHP. Issued April 29, 2021.

OIG evaluated whether Cenikor’s treatment services (a) were provided in accordance with requirements, (b) were provided by qualified staff, and (c) supported the payment received. Issued February 26, 2021.

The audit objectives were to determine whether (a) the affiliate reporting exception met state and contractual requirements and (b) expenses paid to MCNA Texas's affiliate third-party administrator were accurately reported to HHSC and aligned with its affiliate agreement. This audit did not result in recommendations to MCNA Insurance Company. Issued February 25, 2021.

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.

The audit assessed the design and effectiveness of selected security controls over confidential HHS System information stored and processed by Parkland Community Health Plan, Inc. Issued January 20, 2021.

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.

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 Molina accurately and timely adjudicated qualified nursing facility provider clean claims in compliance with selected criteria. Issued December 9, 2020.

The audit evaluated whether there was valid support for the authorization and delivery of fee-for-service durable medical equipment and supplies associated with Medicaid claims submitted by and paid to Maverick Medical Supply as required by state laws, rules, and guidelines. Issued November 30, 2020.

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.

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.

The audit objective was to determine whether Community Health Choice and its subcontracted Pharmacy Benefits Manager, Navitus, administered formularies, the preferred drug list, and prior authorizations in accordance with the contractual requirements. Issued August 31, 2020.