Reports

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.

Presentation on Dental Solicitation Analysis
The OIG Data and Technology presentation on Dental Solicitation Analysis given to stakeholders on June 6 and 7, 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.

OIG Review: Strengthening the Decision-Making Process in Texas Medicaid Rate Setting
This OIG review is an assessment of the Texas Health and Human Services Commission's Medicaid capitation rate setting process. Issued May 23, 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.

Quarterly Report: Quarter 2, FY 2019
The OIG Quarterly Report for the second quarter of fiscal year 2019.

Member Complaints Received by Texas Managed Care Organizations: Series I
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.

Pharmacy Benefit Managers: Inspection of Program Integrity Activities
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.

Durable Medical Equipment: Power Wheelchairs
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.

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.

Technology Presentation to House Appropriations Subcommittee on Article II
The OIG presentation on technology projects given to the House Appropriations Subcommittee on Article II on February 19, 2019.