Reports

Summary of Results: Pharmacy Benefits Manager Navitus Health Solutions, LLC
This report provides a summary and overview of the results and issues identified during audits of three managed care organizations that all subcontracted with Navitus as their pharmacy benefits manager. The audits, which were conducted in 2020, were of Community First Health Plans, Parkland Community Health Plan, and Community Health Choice. Published January 8, 2021.

Value-Based Purchasing Program Integrity Considerations
Value-based purchasing (VBP) models are utilized in government health insurance programs to shift payments from volume to value. This informational report explores how VBP has evolved nationally, Texas’ implementation and a discussion of potential program integrity challenges and considerations related to the OIG’s future work in this space. Issued December 21, 2020. Summary version.

Quarterly Report: Quarter 1, FY 2021
The OIG Quarterly Report for the first quarter of fiscal year 2021.

Joint OIG-MFCU Report
The Joint Annual Report on Fraud and Abuse in Medicaid, compiled by OIG and the Attorney General's Medicaid Fraud Control Unit, for fiscal year 2020.

Child and Adolescent Needs and Strengths (CANS 2.0) Assessment: CANS 2.0 Assessments in Community-Based Care
This inspection assessed whether ACH Child and Family Services conducted CANS 2.0 assessments for children entering community-based care and provided services to those children timely. Published December 18, 2020

Processing of Outlier Nursing Facility STAR+PLUS Claims and Adjustments: Molina Healthcare of Texas
OIG conducted this audit as a follow-up to complaints of nursing facility payments being delayed by more than 90 days and of unprocessed retroactive adjustments. The audit objective was to determine whether Molina accurately and timely adjudicated qualified nursing facility provider clean claims in compliance with selected criteria. Issued December 9, 2020.

MCO Fraud Recoveries Report
The Annual Report on Certain Fraud and Abuse recoveries for fiscal year 2020.

Fee-for-Service Claims Submitted by Maverick Medical Supply: A Texas Medicaid Durable Medical Equipment and Supplies Provider
The audit evaluated whether there was valid support for the authorization and delivery of fee-for-service durable medical equipment and supplies associated with Medicaid claims submitted by and paid to Maverick Medical Supply as required by state laws, rules, and guidelines. Issued November 30, 2020.

Processing of Outlier Nursing Facility STAR+PLUS Claims and Adjustments: Superior HealthPlan
OIG conducted this audit as a follow-up to complaints of nursing facility payments being delayed by more than 90 days and of unprocessed retroactive adjustments. The audit objective was to determine whether Superior HealthPlan accurately and timely adjudicated qualified nursing facility provider clean claims in compliance with selected criteria. Issued November 20, 2020.

Homeward Bound, Inc.: Substance Use Disorder Treatment Provider
Homeward Bound ensured that clients met requirements to be eligible for its substance use disorder programs, including verifying that clients met financial requirements but should strengthen controls related to its HIV and residential detox programs. Issued November 13, 2020.

State Hospital Investigations Report
The Annual Report of State Hospital Investigations for fiscal year 2020.

SSLC Investigations Report
The Annual Report of State Supported Living Center Investigations for fiscal year 2020.

Processes for Hiring and Training Direct Support Professionals: Austin State Supported Living Center
The inspection assessed whether Austin State Supported Living Center, with the assistance of Texas Health and Human Services Commission Human Resources, hires and trains direct support professionals in accordance with Texas Administrative Code requirements. Issued November 9, 2020.

Quarterly Report: Quarter 4, FY 2020
The OIG Quarterly Report for the fourth quarter of fiscal year 2020.

PARIS-VA Match Report
The annual PARIS-VA Match Report for fiscal year 2020.