Audit of Texas Medicaid and CHIP Pharmacy Benefit Services Delivered by Molina and Its PBM, Caremark
The audit determined whether delivery of selected pharmacy benefits by Molina and its subcontracted PBM, Caremark, was effective and in compliance with criteria in the Uniform Managed Care Contract, the Uniform Managed Care Manual, and applicable state rules and statutes. Issued July 19, 2019.

Medical Transportation Management, Inc.: A Texas Medicaid Medical Transportation Organization
The audit was conducted to determine whether MTM’s performance in selected areas was in accordance with contract requirements. Issued July 17, 2019.

Audit of DFPS Child-Specific Contracts
This audit evaluated whether DFPS child-specific contract payments were made to psychiatric hospitals only for services not covered by STAR Health. Issued July 15, 2019.

Audit of STAR+PLUS Service Coordination: Amerigroup Texas
This audit evaluated whether Amerigroup complied with contractual requirements for performing service coordination in support of STAR+PLUS Level 1 members. Issued July 15, 2019.

Audit of Best Med: A Texas Vendor Drug Program Provider
The audit evaluated Best Med to determine whether it properly billed VDP and complied with contractual and state requirements, and evaluated IT general controls to determine whether data used for audit testing was reliable. Issued July 3, 2019.

Audit of STAR+PLUS Service Coordination: UnitedHealthcare Community Plan
This audit evaluated whether United complied with contractual requirements for performing service coordination in support of STAR+PLUS Level 1 members. Issued June 26, 2019.

American Medical Response, Inc.: A Texas Medicaid Medical Transportation Organization
The audit was conducted to determine whether AMR’s performance in selected areas was in accordance with contract requirements. Issued June 18, 2019.

Financial Impact of Clustering Therapy Services During MDS Assessment Look-Back Periods for Texas Medicaid Residents of Long-Term Care Nursing Facilities
Nursing facilities billed Texas Medicaid MCOs an estimated $39.2 million more for resident daily care in 2017, by clustering therapy services during MDS assessment look-back periods, than they would have billed if Texas Medicaid policy prohibited the practice of clustering. Issued June 6, 2019.

Fee-for-Service Claims Submitted by Longhorn Health Solutions: A Texas Durable Medical Equipment Provider
The audit evaluated whether documentation to support the authorization and delivery of fee-for-service DME and supplies associated with Medicaid claims submitted by and paid to Longhorn existed and were completed in accordance with state laws, rules, and guidelines. Issued May 9, 2019.

Audit of Pharmacy Alternatives: A Texas Vendor Drug Program Provider
The audit evaluated Pharmacy Alternatives to determine whether it properly billed VDP and complied with contractual and state requirements, and evaluated IT general controls to determine whether data used for audit testing was reliable. Issued April 25, 2019.

UnitedHealthcare Encounter Data
The objective of the audit was to determine the reliability of UnitedHealthcare sub-capitated encounter data and claims-based encounter data.  Issued February 26, 2019.

Audit of Cook Children’s Teddy Bear Transport: A Texas Medicaid Air Ambulance Provider
The audit evaluated whether paid Medicaid claims for air ambulance services and their associated ground transports were billed in accordance with state rules and guidelines, and contractual requirements. Issued February 26, 2019

Audit of Epic Pediatric Therapy: A Texas Medicaid Speech Therapy Provider
The audit evaluated Epic to determine whether it properly billed the MCO FirstCare Health Plans for Medicaid claims and complied with contractual and state requirements. Issued February 26, 2019.

Audit of Metscript Pharmacy No. 2: A Texas Vendor Drug Program Provider
The audit evaluated Metscript Pharmacy No. 2 to determine whether it properly billed VDP and complied with contractual and state requirements, and evaluated IT general controls to determine whether data used for audit testing was reliable. Issued February 11, 2019.

Bethesda Lutheran Homes and Services: A Texas Medicaid Home and Community-Based Services Program Provider
This audit evaluated whether fee-for-service claims submitted by and paid to Bethesda Lutheran were authorized, documented, and billed in accordance with the HCS provider agreement and with state rules and guidelines. Issued December 14, 2018.