Reporting and Compliance of Affiliate Third-Party Administrator Services: MCNA Insurance Company
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.

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.

Security Controls Over Confidential HHS Information: Parkland Community Health Plan, Inc.
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.

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.

Processing of Outlier Nursing Facility STAR+PLUS Claims and Adjustments: Molina Healthcare of 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 Molina accurately and timely adjudicated qualified nursing facility provider clean claims in compliance with selected criteria. Issued December 9, 2020.

Fee-for-Service Claims Submitted by Maverick Medical Supply: A Texas Medicaid Durable Medical Equipment and Supplies Provider
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.

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.

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.

Pharmacy Benefits Manager Navitus Health Solutions LLC: Community Health Choice
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.

Pharmacy Benefits Manager Navitus Health Solutions LLC: Parkland Community Health Plan
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.

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.

Processing of Outlier Nursing Facility STAR+PLUS Claims and Adjustments: UnitedHealthcare Community Plan
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.

Processing of Outlier Nursing Facility STAR+PLUS Claims and Adjustments: Cigna-HeathSpring
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.

Pharmacy Benefits Manager Navitus Health Solutions LLC: Community First Health Plans
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.

Durable Medical Equipment Delivered to Deceased Beneficiaries: Longhorn Health Solutions
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.