Medicaid Claims for Bradley Frank
The OIG Audit and Inspections Division contracted Myers and Stauffer, LC to audit behavioral health records to verify services provided to recipients, paid by Texas Medicaid. Issued June 15, 2020.
June 2020
May 2020
Audit of Medicaid and CHIP MCO Special Investigative Units: Molina Healthcare of Texas
The audit evaluated Molina’s policies and practices associated with preventing, detecting, investigating, and reporting fraud, waste and abuse. Issued May 22, 2020.
Tarrytown Expocare, LLC: A Texas Vendor Drug Program Provider
The audit evaluated Tarrytown Expocare, LLC 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 May 11, 2020.
April 2020
Security Controls Over Confidential HHS System Information: El Paso Health
The audit assessed the design and effectiveness of selected security controls over confidential HHS System information stored and processed by El Paso Health. Issued April 24, 2020.
March 2020
Medicaid STAR+PLUS Nursing Facility Risk Groups: Reporting Errors Affected Risk Group Assignments
The audit focused on members with a discrepancy between utilization and nursing facility risk group categorization for at least 12 months during the audit scope and concluded that HHSC overpaid $1.38 million to MCOs for Medicaid recipients not eligible for managed care. Published March 30, 2020.
February 2020
STAR+PLUS Waiver Program Assessments and Services Delivered: Amerigroup Insurance Company
This audit determined whether Amerigroup properly assessed members to participate in the Home and Community Based Services (HBCS) Waiver in the Medicaid Rural Service Area (MRSA) West. Issued February 28, 2020.
Collin County MHMR Center: A Local Intellectual and Developmental Disability Authority Performance Contract
This audit tested whether Collin County MHMR Center coordinated services to enrollees, monitored and evaluated service delivery, and reported general revenue expenses according to contract requirements. Issued February 28, 2020. Revised March 6, 2020.
Easter Seals Rio Grande Valley: A Texas DFPS Contractor
The audit was to determine whether controls over contract funds were in place and data was reported to DFPS in accordance with contract terms. No issues were noted. Issued February 26, 2020.
Audit of City Drug Company: A Texas Vendor Drug Program Provider
The audit evaluated City Drug Company 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 20, 2020.
January 2020
Audit of DentaQuest USA Insurance Company: A Texas Medicaid and CHIP Dental Maintenance Organization
The audit objective was to evaluate the DentaQuest’s effectiveness in complying with selected contract requirements, achieving related contract outcomes, and reporting financial and performance results to HHSC. Issued January 9, 2020.
December 2019
Security Controls Over Confidential HHS System Information: Children’s Medical Center Health Plan
The audit assessed the design and effectiveness of selected security controls over confidential HHS System information stored and processed by Children’s Medical Center Health Plan. Issued December 20, 2019.
Summary of Results: Audits of Texas Medicaid Medical Transportation Organizations
This audit report summarizes non-emergency medical transportation services in Texas Medicaid managed transportation organizations, based on the results of four audits performed by the OIG Audit Division. Issued December 3, 2019.
August 2019
Audit of Selected Services to STAR Kids Members in the Medically Dependent Children Program: Cook Children’s Health Plan
The audit determined whether services were authorized and provided to STAR Kids members in MDCP who received private duty nursing, and service coordination activities, assessments, and service plans supported the services for MDCP members who received private duty nursing. Issued August 30, 2019.
Audit of MCNA Insurance Company: A Texas Medicaid and CHIP Dental Maintenance Organization
The audit objective was to evaluate the MCNA’s effectiveness in complying with selected contract requirements, achieving related contract outcomes, and reporting financial and performance results to HHSC. Issued August 30, 2019.
Audit of Management of the STAR Kids and STAR Health Programs Through Monitoring Contract Activities: HHSC Medicaid and CHIP Services
The audit determined whether Medicaid and CHIP Services, through monitoring selected contract deliverables, effectively managed the STAR Kids and STAR Health programs for the Medically Dependent Children Program (MDCP). Issued August 30, 2019.