Reports

The Consolidated Senate Bill 30 Annual Report for fiscal year 2021.

The OIG Audit Division contracted Myers and Stauffer LC to audit 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 31, 2021.

The inspection focused on whether FRAC periodically verifies that DSP claims are valid and adequately supported, conducts retrospective reviews of DSP claims, and implemented policies and procedures to ensure delivery supplemental payment claims are processed timely and accurately. Issued August 31, 2021.

The inspection focused on mental health targeted case management and mental health rehabilitative services provided by local mental health authorities (LMHAs) and local behavioral health authority (LBHA) contracted providers. Issued August 30, 2021.

OIG evaluated whether Cenikor’s Region 11 residential withdrawal management and intensive residential treatment services (a) were provided in accordance with selected regulations and contractual requirements and (b) supported the payment received. Issued August 26, 2021.

The OIG Audit Division contracted Myers and Stauffer LC to audit whether pharmacy 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 26, 2021.

The audit objective was to determine if Rebound performed co-treatment services, which occur when two or more therapy disciplines are performed concurrently, were billed correctly. Issued August 26, 2021.

The audit objective was to evaluate whether Community Options, Inc. provided Medicaid beneficiaries living in three- and four-person residences with safe and healthy living environments, as defined by the HHSC Waiver Survey and Certification Residential Checklist and the COVID-19 emergency rules for the Home and Community-Based Services program. Issued August 26, 2021.

This inspection determined the second level review process is operating effectively to detect errors and prevent distribution of ineligible SNAP benefits. As a result, no observations were identified for this inspection. Issued August 25, 2021.

The OIG Audit Division contracted Myers and Stauffer LC to audit whether pharmacy 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 25, 2021.

The audit objective was to evaluate whether Kenmar Residential HCS Services, Inc. provided Medicaid beneficiaries living in three- and four-person residences with safe and healthy living environments, as defined by the HHSC Waiver Survey and Certification Residential Checklist and the COVID-19 emergency rules for the Home and Community-Based Services program. Issued August 23, 2021.

The audit objectives were to determine whether (a) the Retrospective Cost Settlement statements for the unaudited periods of the original contract, as amended, with HHSC, contract years 2019 and 2020, were reasonably stated and (b) NorthgateArinso, Inc. was in compliance with a selected renewal contract requirement for information security. Issued August 20, 2021.

The audit evaluated Aetna’s policies and practices associated with preventing, detecting, investigating, and reporting fraud, waste and abuse. Issued August 18, 2021.

The audit objectives were to determine whether Rx Plus Pharmacy of Live Oak (a) properly billed for paid claims associated with Medicaid members enrolled with Superior HealthPlan, Inc. and (b) complied with applicable contractual, state, and federal requirements. Issued August 13, 2021.

OIG evaluated whether Cenikor’s Region 4 residential withdrawal management and intensive residential treatment services (a) were provided in accordance with selected regulations and contractual requirements and (b) supported the payment received. Issued August 13, 2021.