Reports

Executive Summary

This inspection examined the processes Amerigroup, Blue Cross and Blue Shield of Texas, Dell Children’s Health Plan, Molina Healthcare of Texas, and United Healthcare Community Plan have for ensuring laboratory service providers have the appropriate CLIA certification prior to paying submitted claims. Issued July 12, 2022. OIG Report No. INS-22-004.

Executive Summary

This inspection examined the processes Aetna Better Health of Texas, Community First Health Plans, Driscoll Health Plan, and Parkland Community Health Plan have for ensuring laboratory service providers have the appropriate CLIA certification prior to paying submitted claims. Issued July 11, 2022. OIG Report No. INS-22-003.

Executive Summary

This inspection examined the processes Community Health Choice, FirstCare HealthPlans, Scott & White Health Plan, and Texas Children’s Health Plan have for ensuring laboratory service providers have the appropriate CLIA certification prior to paying submitted claims. Issued July 11, 2022. OIG Report No. INS-22-002.

The inspection objective was to determine whether the licensed nursing hours recorded at the Villa at Mountain View supported the hours submitted to the U.S. Centers for Medicare and Medicaid Services (CMS) in compliance with federal requirements. The inspection did not result in any recommendations to the Villa at Mountain View. Issued February 17, 2022. OIG Report No. INS-22-001.

The inspection focused on whether FRAC periodically verifies that DSP claims are valid and adequately supported, conducts retrospective reviews of DSP claims, and implemented policies and procedures to ensure delivery supplemental payment claims are processed timely and accurately. Issued August 31, 2021.

The inspection focused on mental health targeted case management and mental health rehabilitative services provided by local mental health authorities (LMHAs) and local behavioral health authority (LBHA) contracted providers. Issued August 30, 2021.

This inspection determined the second level review process is operating effectively to detect errors and prevent distribution of ineligible SNAP benefits. As a result, no observations were identified for this inspection. Issued August 25, 2021.

The objective was to understand whether MCOs have processes in place for deployment of current NCCI edits and how often those edits are updated. Issued August 12, 2021.

This inspection assessed whether the reduction of Medicaid members' mental health services by LMHAs was documented and in compliance with Texas Administrative Code and Texas Resilience and Recovery Utilization Management Guidelines: Adult Mental Health Services. Issued July 28, 2021.

OIG completed an inspection to determine whether fee-for-service telemonitoring provider services were consistent with selected state requirements. No exceptions to requirements were observed. Issued: April 29, 2021.

This inspection assessed whether HHSC-HR performed preemployment due diligence checks for direct support professionals hired to work at SSLCs consistent with (a) Texas Administrative Code requirements and (b) HHSC-HR policies and procedures. Issued February 25, 2021.

This inspection assessed whether ACH Child and Family Services conducted CANS 2.0 assessments for children entering community-based care and provided services to those children timely. Published December 18, 2020

The inspection assessed whether Austin State Supported Living Center, with the assistance of Texas Health and Human Services Commission Human Resources, hires and trains direct support professionals in accordance with Texas Administrative Code requirements. Issued November 9, 2020.

Ths report details the inspection to determine if Texas Medicaid Healthcare Partnership - Third Party Liability has effective processes to recover HHSC identifiable funds from the Texas Comptroller of Public Accounts, Unclaimed Property Program. Issued November 20, 2019.

 This report details the inspection to determine if Managed Care Organizations' complaint intake and resolution processes are consistent with the Uniform Managed Care Manual and Uniform Managed Care Contract requirements. Issued October 4, 2019.