January 2019

Inspections

Automated Monthly Social Security Number Verification
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.

September 2018

Inspections

Duplicate Capitation Payments to Managed Care
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.

August 2018

June 2018

Inspections

Multiple Medicaid Identification Numbers
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.

May 2018

Inspections

Electronic Visit Verification System
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.

Inspections

Medicaid Payments for Deceased Clients
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.

October 2017

Inspections

Treasury Offset Program
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.

Inspections

Speech Therapy
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.

July 2017

Inspections

Pediatric Dental Sedation
This report details the inspection of Texas Medicaid providers to determine if dental sedation procedures performed on Medicaid pediatric patients are medically necessary and meet the standard of care. Issued July 14, 2017.

May 2017

Inspections

Opioid Drug Utilization
This report details the inspection of Texas Medicaid efforts to reduce prescription opioid abuse and overutilization. Issued May 30, 2017.