Reports

Inpatient Psychiatric Hospitals: Cypress Creek Hospital
Executive Summary

The audit objective was to determine whether Cypress Creek completed admission, commitment, and specific consent requirements for STAR+PLUS members receiving inpatient psychiatric services in accordance with selected federal and state regulations, rules, and policies. Issued August 25, 2022. OIG Report No. AUD-22-025.

Texas Home Modification Services
The OIG Audit and Inspections Division contracted DK Partners to determine whether delivery of Durable Medical Equipment and submissions of Medicaid and CHIP managed care claims by Texas Home Modification Services were in accordance with applicable Federal and State Medicaid laws, regulations, rules, policies, and contractual requirements. Issued August 26, 2022.

Administrative and Medical Expenses Reported on Financial Statistical Reports: UnitedHealthcare Community Plan of Texas, L.L.C. and UnitedHealthcare Insurance Company, Inc.
Executive Summary

The audit objective was to determine whether (a) UnitedHealthcare reported expenses on selected components of its Medical and Combined financial statistical reports submitted to the Texas Health and Human Services Commission (HHSC) in accordance with contract requirements and laws and (b) the related internal controls over the preparation of the financial statistical reports were designed and operating effectively. Issued August 24, 2022. OIG Report No. AUD-22-024.

Nursing Facility Emergency Preparedness: Mystic Park Nursing and Rehabilitation Center
Executive Summary

The inspection objective was to determine whether Mystic Park Nursing and Rehabilitation Center followed select state and federal requirements for emergency preparedness. Issued August 25, 2022. OIG Report No. INS-22-010.

Clinical Laboratory Improvement Amendments (CLIA) Certification: Texas Medicaid and Healthcare Partnership (TMHP)
Executive Summary

The inspection objective was to determine whether TMHP has controls to ensure payments made to laboratories are only for services covered under the laboratory's CLIA certification level. Issued August 19, 2022. OIG Report No. INS-22-009.

Managed Care Pharmacy Claims Paid to ReCept Pharmacy #1: A Managed Care Network Provider Contracted Under Aetna Better Health of Texas, Inc.
Executive Summary

The audit objective was to determine whether ReCept Pharmacy #1 (a) properly billed for paid claims associated with Medicaid and Children’s Health Insurance Program (CHIP) members enrolled with Aetna Better Health of Texas, Inc. and (b) complied with applicable contractual, state, and federal requirements. Issued August 22, 2022. OIG Report No. AUD-22-023.

Acorn Pharmacy
The OIG Audit and Inspections Division contracted Myers and Stauffer LC to audit whether pharmacy claims billed and paid under the state Medicaid program were in accordance with applicable state and federal Medicaid laws, regulations, rules, policies, and contractual requirements. Issued August 19, 2022.

Emergency Ambulance Services at American Medical Response
Executive Summary

The audit objective was to determine whether American Medical Response ensured its contractor billed claims to managed care organizations in accordance with applicable statutes, rules, and procedures in the managed care environment. Issued August 18, 2022. OIG Report No. AUD-22-022.

Amber Pharmacy
The OIG Audit and Inspections Division contracted Myers and Stauffer LC to audit whether pharmacy claims billed and paid under the state Medicaid program were in accordance with applicable state and federal Medicaid laws, regulations, rules, policies, and contractual requirements. Issued August 19, 2022.

Nursing Facility Staffing Hours Verification: Mira Vista Court
Executive Summary

The inspection objective was to determine whether the direct care licensed nursing hours recorded at Mira Vista Court supported the hours submitted to the U.S. Centers for Medicare and Medicaid Services in compliance with federal requirements. Issued August 16, 2022. OIG Report No. INS-22-008.

Administrative Expenses Reported by Molina Healthcare of Texas, Inc. on Its Financial Statistical Report
Executive Summary

The audit objective was to determine whether (a) Molina Healthcare of Texas, Inc. reported expenses on its 334-day 2020 Combined Administrative and Quality Improvement Expenses financial statistical report submitted to the Texas Health and Human Services Commission in accordance with contract requirements and laws and (b) the related internal controls over the preparation of the financial statistical report were designed and operating effectively. Issued August 16, 2022. OIG Report No. AUD-22-021.

Home and Community Support Services Agencies Oversight of Attendants: Elara Caring
Executive Summary

The audit objective was to evaluate whether Elara Caring (a) developed and performed individualized service plans, (b) performed visit maintenance for selected EVV transactions in accordance with selected regulations, and (c) performed selected oversight activities. Issued August 12, 2022. OIG Report No. AUD-22-019

Home and Community Support Services Agencies Oversight of Attendants: Girling Community Care
Executive Summary

The audit objective was to evaluate whether Girling (a) developed and performed individualized service plans, (b) performed visit maintenance for selected EVV transactions in accordance with selected regulations, and (c) performed selected oversight activities. Issued August 12, 2022. OIG Report No. AUD-22-020

 

The Sexually Transmitted Disease/Human Immunodeficiency Virus (STD/HIV) Prevention Services Grant Program: City of Houston Health Department
Executive Summary

The audit objective was to determine whether the City of Houston Health Department had processes and controls in place to ensure it administered the STD/HIV Prevention Services Grant Program in accordance with selected grant agreement requirements for performance, data management, reporting, and grant expenditures. Issued August 11, 2022. OIG Report No. AUD-22-018.

Nursing Facility Staffing Hours Verification: Westchase Health and Rehabilitation Center
Executive Summary

The inspection objective was to determine whether the direct care licensed nursing hours recorded at Westchase Health and Rehabilitation Center supported the hours submitted to the U.S. Centers for Medicare and Medicaid Services in compliance with federal requirements. Issued August 9, 2022. OIG Report No. INS-22-006.