Cenikor Foundation: Region 4 Substance Use Disorder Treatment Provider
OIG evaluated whether Cenikor’s Region 4 residential withdrawal management and intensive residential treatment services (a) were provided in accordance with selected regulations and contractual requirements and (b) supported the payment received. Issued August 13, 2021.

Benchmark Family Services, Inc: A Former DFPS Contractor
OIG evaluated whether Benchmark had processes and controls in place to ensure it provided foster care services in accordance with selected contract terms and applicable requirements. Issued August 12, 2021.

Fee-for-Service Claim Payments for Pregnant Women with Medicaid Managed Care Eligibility
The audit objective was to evaluate the effectiveness of processes and controls designed to prevent fee-for-service claims from being paid for services covered by MCOs. Issued July 30, 2021.

Security Controls Over Confidential HHS Information: Scott and White Health Plan
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 30, 2021.

Healthy Texas Women Family Planning Program Contract Compliance: The Heidi Group
The audit objective was to determine whether (a) expenses reimbursed were allowable and (b) expenses were allocated as required under the terms of its Healthy Texas Women program and Family Planning Program contracts, which ended in December 2018. Issued July 30, 2021.

Data Processing and Integrity of Medicaid Eligibility Determinations: TIERS
The audit objective was to determine whether the Texas Integrated Eligibility Redesign System (TIERS) system and process controls were adequate to reasonably ensure that Medicaid eligibility determinations were accurate based on selected eligibility elements, including citizenship, residency, and identification of deceased individuals.

Acadian Ambulance Services
The audit objective was to determine whether Acadian billed selected managed care organizations for claims for ground emergency ambulance services in accordance with applicable statutes, rules and procedures. Issued July 28, 2021.

Women, Infants, and Children’s Nutrition Program (WIC): City of Laredo Health Department
The audit objective was to determine if the City of Laredo Health Department WIC program had financial processes in place to ensure compliance with applicable federal and state program rules, guidelines and contractual requirements for the Texas Health and Human Services WIC program. This audit did not result in recommendations to the City of Laredo Health Department. Issued July 23, 2021.

Santa Cruz Adult Day Care
The OIG Audit Division contracted Myers and Stauffer LC to audit adult day care claims to verify services provided to recipients, paid by Texas Medicaid. Issued July 14, 2021.

Co-Treatment Therapy Billing: MindWorks Rehabilitation Center
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.

Managed Care Organization Reimbursements to Pharmacy Benefit Managers: Superior HealthPlan
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.

Summary of Results: Processing of Outlier Nursing Facility STAR+PLUS Claims and Adjustments
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.

Driscoll Health Plan: A Texas Medicaid and CHIP Managed Care Organization
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.

Audit of STAR Kids Screening and Assessment Instrument New Enrollment Timeliness
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.

Cenikor Foundation: Region 7 Substance Use Disorder Treatment Provider
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.