Reports

Electronic Visit Verification System
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.

Medicaid Payments for Deceased Clients
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.

Audit of Circle of Care: A Texas Medicaid Speech Therapy Provider
The OIG Audit Division contracted Health Management Systems to audit speech therapy records to verify services provided to recipients paid by Texas Medicaid. Issued May 25, 2018.

Audit of Tropical Texas Behavioral Health: A Texas Behavioral Health Services Provider
The OIG Audit Division contracted Health Management Systems to audit behavioral health records to verify services provided to recipients, paid by Texas Medicaid. Issued May 25, 2018.

Audit of St. Louis Medical Supply: A Durable Medical Equipment Provider
The OIG Audit Division contracted Health Management Systems to audit durable medical equipment records to verify services provided to recipients, paid by Texas Medicaid. Issued May 25, 2018.

Assessment and Evaluation Practices at Mission Nursing and Rehabilitation Center
The audit evaluated Minimum Data Set (MDS) assessments, therapy services charts, medical records, Resource Utilization Group (RUG) levels assigned to residents, and physician orders and certifications for therapy services. Issued May 11, 2018.

IG Presentation to House Human Services Committee: May 9, 2018
This presentation was made by Inspector General Sylvia Hernandez Kauffman on the topic of program integrity in managed care.

Issue Brief: Attendant Care Services
This issue brief provides an overview of attendant care services, which provide Medicaid clients the assistance they need to stay in their community, instead of living in a long-term care (LTC) facility.

Audit of Cook Children’s Home Health: A Texas Vendor Drug Program Provider
The audit evaluated Cook Children’s Home Health 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. Results indicated no exceptions for the claims tested. Issued April 30, 2018.

Audit of R Medical Outreach and Associates: A Durable Medical Equipment Provider
The audit evaluated whether fee-for-service claims for incontinence supplies paid with Medicaid funds were billed in accordance with state laws, regulations, and program requirements. Issued April 27, 2018.

Audit of Medicaid and CHIP MCO SIUs: Driscoll Health Plan
The audit evaluated Driscoll’s policies and practices associated with preventing, detecting, investigating, and reporting fraud, waste, and abuse. Issued April 3, 2018.

Quarterly Report: Quarter 2, FY 2018
The OIG Quarterly Report for the second quarter of fiscal year 2018.

Texas Medicaid and CHIP Managed Care Organizations’ Special Investigative Units Review and Recommendations
This report was submitted to the Legislative Budget Board and the Governor in compliance with the 2018-2019 General Appropriations Act, Senate Bill 1, 85th Legislature, Regular Session, 2017 (Article II, Health and Human Services Commission, Rider 152). Issued March 29, 2018.

Quarterly Report: Quarter 1, FY 2018
The OIG Quarterly Report for the first quarter of fiscal year 2018.

Review of Managed Care Organizations' Cost Avoidance and Waste Prevention Activities
This report was submitted to the Legislative Budget Board and the Governor in compliance with the 2018-2019 General Appropriations Act, Senate Bill 1, 85th Legislature, Regular Session, 2017 (Article II, Health and Human Services Commission, Rider 151.) Issued March 1, 2018.