Managed Care Pharmacy Encounters Paid to Omnicare Pharmacy
Executive Summary - The audit objective was to determine whether Omnicare Pharmacy (a) properly dispensed prescriptions associated with selected encounters for Texas Medicaid members enrolled with Superior HealthPlan, Inc., UnitedHealthcare Community Plan of Texas, L.L.C., and UnitedHealthcare Insurance Company, Inc., and (b) complied with applicable contractual, state, and federal requirements. Issued August 28, 2024. OIG Report No. AUD-24-029.
August 2024
My Health My Resources Concho Valley: A Local Mental Health Authority Contracted with the Texas Health and Human Services Commission
Executive Summary - The audit objective was to determine whether My Health My Resources Concho Valley complied with selected state and contractual requirements. Issued August 27, 2024. OIG Report No. AUD-24-028.
Managed Care Pharmacy Encounters Paid to Meadowbrook Pharmacy
Executive Summary - The audit objective was to determine whether Meadowbrook Pharmacy (a) properly dispensed prescriptions associated with selected encounters for Texas Medicaid and CHIP members enrolled with Cook Children’s Health Plan, Wellpoint Texas, Inc., and Wellpoint Insurance Company and (b) complied with applicable contractual, state, and federal requirements. Issued August 23, 2024. OIG Report No. AUD-24-027.
Follow-Up Assessment on a Previously Published Audit Report — Cenikor Foundation: A Substance Use Disorder Treatment Provider in Region 7
The objective of the follow-up assessment was to determine the resolution status of OIG Audit’s previously identified issues at Cenikor, which included testing the effectiveness of management activities designed to remediate the identified issues. Issued August 22, 2024. OIG Report No. AUD-24-026.
ReCept Pharmacy #31
The OIG Audit and Inspections Division contracted Myers and Stauffer LC to determine 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 20, 2024. OIG Report No. AUD-24-025.
Allergy Immunotherapy Services in Texas Medicaid: Calvary Medical
Executive Summary - The audit objective was to determine whether claims submitted by Calvary Medical Clinic for allergy immunotherapy services complied with selected guidelines. Issued August 16, 2024. OIG Report No. AUD-24-024
Pediatric Home Service
The OIG Audit and Inspections Division contracted Myers and Stauffer LC to determine whether paid MCO medical supply claims billed to, 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 15, 2024. OIG Report No. AUD-24-023.
Comfort & Care Medical Supplies, Inc.
The OIG Audit and Inspections Division contracted Myers and Stauffer LC to determine whether paid MCO DME and medical supply claims billed to, 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 15, 2024. OIG Report No. AUD-24-022.
Nueva Vida Behavioral Health Associates
The OIG Audit and Inspections Division contracted Myers and Stauffer LC to determine whether behavioral health claims billed to, 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 8 2024. OIG Report No. AUD-24-021.
Allergy Testing in Texas Medicaid: Quest Diagnostics Clinical Laboratories, Inc.
Executive Summary - The audit objective was to determine whether claims submitted by Quest Diagnostics for allergy blood tests complied with selected Texas Medicaid Provider Procedure Manual guidelines. Issued August 7, 2024. OIG Report No. AUD-24-019
Alaniz Counseling and Behavioral Center, PC
The OIG Audit and Inspections Division contracted Myers and Stauffer LC to determine whether behavioral health claims billed to, 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 8 2024. OIG Report No. AUD-24-020.
Managed Care Pharmacy Benefit Services- Navitus Health Solutions, LLC
Executive Summary - The audit objective was to determine whether Navitus (a) completed and reported payments and reimbursements for Texas Medicaid and CHIP managed care pharmacy benefit services accurately and in accordance with applicable requirements and (b) effectively designed and operated related internal controls over payments and reporting. Issued August 7, 2024. OIG Report No. AUD-24-018
Case-by-Case Services: Community First Health Plans
Executive Summary - The OIG conducted this inspection to determine whether Community First Health Plans reported case-by-case services in accordance with applicable requirements. Issued August 6, 2024. OIG Report No. INS-24-009
July 2024
Pharmacy Alternatives, LLC
The OIG Audit and Inspections Division contracted Myers and Stauffer LC to determine 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 July 31, 2024. OIG Report No. AUD-24-017.
Cook Children’s Health Plan’s Financial Statistical Reports
Executive Summary - The audit objective was to determine whether Cook Children’s Health Plan (a) reported expenses on its FSRs in accordance with contract requirements and (b) designed and implemented effective internal controls over the preparation of its FSRs. Issued July 23, 2024. OIG Report No. AUD-24-016.