Reports

Executive Summary

The audit objective was to determine whether Maximus accurately, timely, and in accordance with applicable requirements (a) communicated enrollment-related information to members who were determined eligible for Medicaid and CHIP services and (b) received and processed enrollment-related information from those members in state fiscal year 2021. Issued September 2, 2022. OIG Report No. AUD-23-001.

The OIG Audit and Inspections Division contracted Weaver and Tidwell, L.L.P. to audit whether services billed and paid under the state Medicaid program were provided in accordance with applicable state and federal Medicaid laws, regulations, rules, policies, and contractual requirements. Issued August 31, 2022.

The OIG Audit and Inspections Division contracted DK Partners to audit whether delivery of Durable Medical Equipment and submissions of Medicaid and CHIP managed care claims by One Source were in accordance with applicable Federal and State Medicaid laws, regulations, rules, policies, and contractual requirements.  Issued August 31, 2022.

The OIG Audit and Inspections Division contracted Weaver and Tidwell, L.L.P. to audit whether services billed and paid under the state Medicaid program were provided in accordance with applicable state and federal Medicaid laws, regulations, rules, policies, and contractual requirements. Issued August 31, 2022.

The OIG Audit and Inspections Division contracted DK Partners to audit whether delivery of Durable Medical Equipment and submissions of Medicaid and CHIP managed care claims by Aeroflow were in accordance with applicable Federal and State Medicaid laws, regulations, rules, policies, and contractual requirements.  Issued August 30, 2022.

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 29, 2022.

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 29, 2022.

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.

Executive Summary

The audit objective was to determine whether West Oaks 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 26, 2022. OIG Report No. AUD-22-026.

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.

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.

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.

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.

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.

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.