Reports

Supplemental Nutrition Assistance Program: Second Level Review Process
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.

Angleton Health Mart Pharmacy
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.

Health and Safety of Medicaid Beneficiaries in the HHSC Home and Community-Based Services Program: Kenmar Residential HCS Services, Inc.
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.

NorthgateArinso, Inc: A Texas Health and Human Services Commission Contractor
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.

Aetna Better Health of Texas: Special Investigative Unit
The audit evaluated Aetna’s policies and practices associated with preventing, detecting, investigating, and reporting fraud, waste and abuse. Issued August 18, 2021.

Managed Care Pharmacy Claims Paid to Rx Plus Pharmacy of Live Oak: A Managed Care Network Provider Contracted Under Superior HealthPlan, Inc.
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.

Cenikor Foundation: Region 4 Substance Use Disorder Treatment Provider
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.

The National Correct Coding Initiative in Texas Medicaid: Informational Report on Use of NCCI Edits by Managed Care Organizations
The objective was to understand whether MCOs have processes in place for deployment of current NCCI edits and how often those edits are updated. Issued August 12, 2021.

Benchmark Family Services, Inc: A Former DFPS Contractor
OIG evaluated whether Benchmark had processes and controls in place to ensure it provided foster care services in accordance with selected contract terms and applicable requirements. Issued August 12, 2021.

Security Controls Over Confidential HHS Information: Scott and White Health Plan
The audit assessed the design and effectiveness of selected security controls over confidential HHS System information stored and processed by Scott and White Health Plan. Issued July 30, 2021.

Healthy Texas Women Family Planning Program Contract Compliance: The Heidi Group
The audit objective was to determine whether (a) expenses reimbursed were allowable and (b) expenses were allocated as required under the terms of its Healthy Texas Women program and Family Planning Program contracts, which ended in December 2018. Issued July 30, 2021.

Data Processing and Integrity of Medicaid Eligibility Determinations: TIERS
The audit objective was to determine whether the Texas Integrated Eligibility Redesign System (TIERS) system and process controls were adequate to reasonably ensure that Medicaid eligibility determinations were accurate based on selected eligibility elements, including citizenship, residency, and identification of deceased individuals.

Fee-for-Service Claim Payments for Pregnant Women with Medicaid Managed Care Eligibility
The audit objective was to evaluate the effectiveness of processes and controls designed to prevent fee-for-service claims from being paid for services covered by MCOs. Issued July 30, 2021.

Acadian Ambulance Services
The audit objective was to determine whether Acadian billed selected managed care organizations for claims for ground emergency ambulance services in accordance with applicable statutes, rules and procedures. Issued July 28, 2021.

Documentation of Reductions to Authorized Levels of Care: Local Mental Health Authorities in Texas
This inspection assessed whether the reduction of Medicaid members' mental health services by LMHAs was documented and in compliance with Texas Administrative Code and Texas Resilience and Recovery Utilization Management Guidelines: Adult Mental Health Services. Issued July 28, 2021.