MCO Provider Claims Appeals: FirstCare Health Plans
Executive Summary - The OIG conducted this inspection to determine whether FirstCare tracks, resolves, and reports provider claims appeals as required. Issued November 21, 2024. Report No. INS-25-004

Case-by-Case Services: Parkland Community Health Plan
Executive Summary - The OIG conducted this inspection to determine whether Parkland Community Health Plan reported case-by-case services in accordance with applicable requirements. Issued November 4, 2024. OIG Report No. INS-25-003

Nursing Facility Abuse, Neglect, Exploitation, and Misappropriation: Midtowne Meadows Health and Rehab
Executive Summary - The inspection objective was to determine whether Midtowne Meadows has processes and procedures to document and report abuse, neglect, exploitation, and misappropriation incidents as required by state law. Issued October 28, 2024. Report No. INS-25-002

Case-by-Case Services: Superior HealthPlan, Inc., and Superior HealthPlan Network
Executive Summary - The OIG conducted this inspection to determine whether Superior HealthPlan reported case-by-case services in accordance with applicable requirements. Issued October 22, 2024. OIG Report No. INS-25-001

Case-by-Case Services: Community First Health Plans
Executive Summary - The OIG conducted this inspection to determine whether Community First Health Plans reported case-by-case services in accordance with applicable requirements. Issued August 6, 2024. OIG Report No. INS-24-009

Case-by-Case Services: Community Health Choice
Executive Summary - The OIG conducted this inspection to determine whether Community Health Choice reported case-by-case services in accordance with applicable requirements. Issued July 11, 2024. OIG Report No. INS-24-008 

Follow-Up Assessment on Previously Issued Inspections Recommendations: Nursing Facility Staffing Hours Verification—Liberty Health Care Center
OIG conducted this follow-up assessment of the previously issued inspection report titled “Nursing Facility Staffing Hours Verification: Liberty Health Care Center” to determine whether the recommendation previously issued by OIG Inspections was implemented. Issued April 5, 2024. No. INS-24-007
 

Mental Health Private Psychiatric Bed Funds: Tropical Texas Behavioral Health
Executive Summary - The inspection objective was to determine whether Tropical used mental health private psychiatric bed funds in accordance with certain elements of the statement of work in its HHSC contract. Issued February 15, 2024. No. INS-24-006

Follow-Up Assessment on Previously Issued Inspections Recommendation: Nursing Facility Staffing Hours Verification-Mira Vista Court
OIG conducted this follow-up assessment of the previously issued inspection report titled “Nursing Facility Staffing Hours Verification: Mira Vista Court” to determine whether the recommendation previously issued by OIG Inspections was implemented. Issued January 12, 2024. No. INS-24-005

Ambulance Claims Oversight: Non-Medically Necessary Claims
The Inspections Division conducted a data review to determine whether non-medically necessary ambulance claims were denied in compliance with applicable requirements. Issued January 9, 2024. No. INS-24-004.

Managed Care Claims Submitted by Respiratory & Medical Homecare Unlimited
The inspection objective was to determine whether Respiratory & Medical Homecare Unlimited supported its wound care supply claims according to guidelines. Issued October 31, 2023. OIG Report No. INS-24-003

Managed Care Claims Submitted by Medical Plus Supplies
The inspection objective was to determine whether Medical Plus Supplies supported its wound care supply claims according to guidelines. Issued October 10, 2023. OIG Report No. INS-24-002

Managed Care Claims Submitted by Byram Healthcare Centers
Executive Summary - The inspection objective was to determine whether Byram supported its wound care supply claims according to guidelines. Issued October 6, 2023. OIG Report No. INS-24-001

Ambulance Claims Oversight: Community First Health Plans
Executive Summary - The inspection objective was to determine whether Community First Health Plans has processes and controls to ensure non-medically necessary ambulance claims are denied in compliance with applicable requirements. Issued August 31, 2023. OIG Report No. INS-23-012.

Ambulance Claims Oversight: Driscoll Health Plan
Executive Summary - The inspection objective was to determine whether Driscoll has processes and controls to ensure non-medically necessary ambulance claims are denied in compliance with applicable requirements. Issued August 29, 2023. OIG Report No. INS-23-011.