Reports

August 2019

March 2019

February 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.

    Category: Inspections
  • 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.

    Category: Inspections

January 2019

September 2018

  • 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.

    Category: Inspections

August 2018

June 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.

    Category: Inspections

May 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.

    Category: Inspections
  • 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.

    Category: Inspections

October 2017

  • 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.

    Category: Inspections
  • 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.

    Category: Inspections

July 2017

  • 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.

    Category: Inspections