Reports

Wellpoint Texas Special Investigative Unit
Executive Summary - The OIG evaluated the effectiveness of Wellpoint’s special investigative unit performance in (a) preventing, detecting, and investigating fraud, waste, and abuse and (b) reporting reliable information on SIU activities, results, and recoveries to the Texas Health and Human Services (HHS) Office of Inspector General (OIG). Issued February 28, 2025. OIG Report No. AUD-25-009.

Case-by-Case Services: Texas Children’s Health Plan
Executive Summary - The OIG conducted this inspection to determine whether Texas Children’s Health Plan reported case-by-case services in accordance with applicable requirements. Issued February 27, 2025. OIG Report No. INS-25-005

Follow-Up Assessment on a Previously Published Audit Report: Managed Care Claims Submitted by Cook Children’s Home Health
The objective of this follow-up assessment was to determine the resolution status of OIG Audit’s previously identified issues at Cook Children’s Home Health, which included testing the effectiveness of management activities designed to remediate identified issues. Issued February 11, 2025. OIG Report No. AUD-25-008.

Joint Annual Interagency Coordination Report
The Joint Annual Interagency Coordination Report summarizes the collaborative activities of the HHS Office of Inspector General and Office of Attorney General Civil Medicaid Fraud Division and Medicaid Fraud Control Unit in the detection and prevention of fraud, waste and abuse in Texas Medicaid.

UnitedHealthcare Dental’s Financial Statistical Reports
Executive Summary - The audit objective was to determine whether UnitedHealthcare Dental (a) reported expenses on its financial statistical reports (FSRs) in accordance with applicable requirements and (b) designed and implemented effective internal controls over the preparation of its FSRs. Issued January 23, 2025. OIG Report No. AUD-25-007.

Quarterly Report: Quarter 1, FY 2025
The OIG published its first quarterly report for fiscal year 2025, summarizing the agency’s work and results achieved between September 1, 2024, and November 30, 2024.

Annual Report on Certain Fraud and Abuse Recoveries by Managed Care Organizations
Required by Texas Government Code, Section 531.1132, the Annual Report on Certain Fraud and Abuse Recoveries by Managed Care Organizations details recoveries during the preceding fiscal year resulting from investigations by managed care organization special investigative units.

Summary of Results: Psychiatric and Behavioral Health Teleservices in Texas Medicaid and CHIP Audits of Selected Texas Medicaid and CHIP Providers
Executive Summary - This report summarizes the results and conclusions of five audits conducted due to the increased risk associated with teleservice claims for evaluation and management, skills training, case management, and behavioral health services including psychiatry, psychotherapy, and occupational, physical and speech therapies caused by the increase in teleservices provided during the COVID-19 public health emergency. Issued November 21, 2024. OIG Report No. AUD-25-006.

MCO Provider Claims Appeals: FirstCare Health Plans
Executive Summary - The OIG conducted this inspection to determine whether FirstCare tracks, resolves, and reports provider claims appeals as required. Issued November 21, 2024. Report No. INS-25-004

Case-by-Case Services: Parkland Community Health Plan
Executive Summary - The OIG conducted this inspection to determine whether Parkland Community Health Plan reported case-by-case services in accordance with applicable requirements. Issued November 4, 2024. OIG Report No. INS-25-003

Managed Care Pharmacy Benefit Services: Aetna Better Health of Texas Inc. and CaremarkPCS Health, LLC
Executive Summary - The audit objective was to determine whether Aetna and Caremark had processes and controls in place to ensure payments and reimbursements for managed care pharmacy benefit services (a) were based on net reimbursements to pharmacies, (b) were accurately reported to the state of Texas, and (c) complied with the Uniform Managed Care Contract and other applicable requirements. Issued October 31, 2024. Report No. AUD-25-004

Managed Care Pharmacy Benefit Services: Wellpoint Texas, Inc.; Wellpoint Insurance Company; CarelonRx Inc.; and CaremarkPCS Health, LLC
Executive Summary - The audit objective was to determine whether Wellpoint, CarelonRx, and Caremark had processes and controls in place to ensure payments and reimbursements for managed care pharmacy benefit services (a) were based on net reimbursements to pharmacies, (b) were accurately reported to the state of Texas, and (c) complied with the Uniform Managed Care Contract and other applicable requirements. Issued October 31, 2024. Report No. AUD-25-005 

Midtowne Meadows Health and Rehab: Nursing Facility Abuse, Neglect, Exploitation, and Misappropriation
Executive Summary - The inspection objective was to determine whether Midtowne Meadows has processes and procedures to document and report abuse, neglect, exploitation, and misappropriation incidents as required by state law. Issued October 28, 2024. Report No. INS-25-002

State Hospital Investigations Report FY 2024
The Annual Report of State Hospital Investigations for fiscal year 2024.

State Supported Living Center Investigations Report FY 2024
The Annual Report of State Supported Living Center Investigations for fiscal year 2024.