Reports

The audit objective was to determine whether Parkland 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.

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.

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 UnitedHealthcare accurately and timely adjudicated qualified nursing facility provider clean claims in compliance with selected criteria. Issued August 28, 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 Cigna-HealthSpring accurately and timely adjudicated qualified nursing facility provider clean claims in compliance with selected criteria. Issued August 26, 2020.

The audit objective was to determine whether Community First and its subcontracted Pharmacy Benefits Manager, Navitus, administered formularies, the preferred drug list, and prior authorizations in accordance with the contractual requirements. Issued August 26, 2020.

This limited-scope audit explored the prevalence of DME services being provided after a Medicaid beneficiary’s death. For the deliveries tested, verification systems showed the beneficiary as eligible at the time of delivery. Therefore, this audit did not result in recommendations to Longhorn. Issued August 25, 2020.

The audit assessed the design and effectiveness of selected security controls over confidential HHS System information stored and processed by Aetna Better Health of Texas. Issued August 24, 2020.

The OIG Audit Division contracted Myers and Stauffer, LC to audit pharmacy claims to verify services provided to recipients, paid by Texas Medicaid. Issued August 21, 2020.

The OIG Audit Division contracted Myers and Stauffer, LC to audit pharmacy claims to verify services provided to recipients, paid by Texas Medicaid. Issued August 21, 2020.

This limited-scope audit explored the prevalence of DME services being provided after a Medicaid beneficiary’s death. For the deliveries tested, verification systems showed the beneficiary as eligible at the time of delivery. Therefore, this audit did not result in recommendations to Nextra. Issued August 20, 2020.

This limited-scope audit explored the prevalence of DME services being provided after a Medicaid beneficiary’s death. For the deliveries tested, verification systems showed the beneficiary as eligible at the time of delivery. Therefore, this audit did not result in recommendations to All Star. Issued August 14, 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 Aveanna as required by state laws, rules, and guidelines. Issued July 30, 2020.

This audit determined whether contract controls ensured AACOG coordinated services to enrollees, monitored service delivery and reported general revenue expenses according to contract requirements, and documented paid encounters. Issued July 29, 2020.

The audit evaluated Infinity Pharmacy Solutions, LLC to determine whether it properly billed VDP and complied with contractual and state requirements, and evaluated IT general controls to determine whether data used for audit testing was reliable. Issued June 23, 2020.

The OIG Audit and Inspections Division contracted Myers and Stauffer, LC to audit behavioral health records to verify services provided to recipients, paid by Texas Medicaid. Issued June 15, 2020.