Reports

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.

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.

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.

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.

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.

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.

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.

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.

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.

The audit objective was to determine if the City of Laredo Health Department WIC program had financial processes in place to ensure compliance with applicable federal and state program rules, guidelines and contractual requirements for the Texas Health and Human Services WIC program. This audit did not result in recommendations to the City of Laredo Health Department. Issued July 23, 2021.