Reports

This report details the inspection to determine if Texas Medicaid ensures only eligible out-of-state Texas residents receive benefits. Issued August 30, 2019.

This report details the inspection to determine the accuracy of data contained in the online provider directories of managed care organizations. Issued August 23, 2019.

This report details the inspection to determine if managed care organization member complaint intake processes are consistent with the Uniform Managed Care Contract and Uniform Managed Care Manual requirements. Issued March 7, 2019.

This report details the inspection to determine the program integrity activities pharmacy benefit managers use to detect fraud, waste, and abuse of Medicaid-funded prescriptions. Issued February 27, 2019.

This report details the inspection to determine if documentation requirements are being met when Medicaid clients receive power wheelchairs from durable medical equipment suppliers. Issued February 27, 2019.

This report details the inspection to determine if home health providers obtain and evaluate background information on attendant care personnel to ensure client safety. Issued January 16, 2019.

This report details the inspection to determine if HHSC Access and Eligibility Services properly addresses non-verified Social Security numbers to prevent ineligible client enrollment in Texas Medicaid. Issued January 3, 2019.

This report details the inspection to determine if Texas Medicaid processes identify or prevent duplicate capitation payments to managed care organizations for clients enrolled in both Medicaid and the Children’s Health Insurance Program. Issued September 4, 2018.

This report details the inspection to determine whether HHSC Customer Care Center responses to OIG match action alerts prevent Supplemental Nutrition Assistance Program and Medicaid overpayments. Issued August 21, 2018.

This report details the inspection to determine if Community Attendant Services are billed to Medicaid and rendered to clients in accordance with program requirements. Issued August 7, 2018.

This report details the inspection to determine if Texas Medicaid made multiple capitation payments for clients with multiple Medicaid ID numbers. Issued June 8, 2018.

This report details the inspection of the Electronic Visit Verification (EVV) System to determine how effective it is at verifying that home visits for Medicaid clients occurred and at confirming that home services were provided. Issued May 29, 2018.

This report details the inspection of capitation payments made for deceased clients in the Texas Medicaid system, to determine how processes can be strengthened to identify and recoup those payments. Issued May 29, 2018.

This report details the inspection of procedures to maximize recovery of Supplemental Nutrition Assistance Program overpayments through the Treasury Offset Program. Issued October 20, 2017.

This report details the inspection of Texas Medicaid providers to examine MCO controls for prior authorization, best practices to strengthen controls, medical necessity for authorization, and speech therapy utilization rates across managed care service areas. Issued October 2, 2017.