Reports

The OIG Audit Division contracted Myers and Stauffer LC to audit adult day care claims to verify services provided to recipients, paid by Texas Medicaid. Issued July 14, 2021.

The IG Quarterly Report for the third quarter of fiscal year 2021.

OIG conducted this audit to ensure co-treatment services, which occur when two or more therapy disciplines are performed concurrently, were billed correctly. The audit found no instances of co-treatment and made no findings. Issued June 22, 2021.

OIG conducted a series of audits in 2020 of State of Texas Access Reform PLUS (STAR+PLUS) nursing facility claims paid by the five Texas managed care organizations (MCOs) that participate in the STAR+PLUS program. This summary report details issues found across all five audits and the MCOs’ progress since they were published. Published May 28, 2021.

The audit objective was to determine whether Superior had controls in place to ensure its payments to its subcontracted PBM (a) were based on actual amounts paid to pharmacies, (b) were accurately reported to the state, and (c) complied with other applicable requirements related to spread pricing. Published May 28, 2021.

The audit objective was to determine whether Driscoll accurately reported selected administrative expenses to HHSC, including a review of internal controls related to developing the Administrative Expenses Financial Statistical Report. Published May 27, 2021.

OIG completed an inspection to determine whether fee-for-service telemonitoring provider services were consistent with selected state requirements. No exceptions to requirements were observed. Issued: April 29, 2021.

OIG conducted an audit of select long-term care eligibility processes at the Texas Medicaid and Healthcare Partnership (TMHP) for new members enrolling in the Medically Dependent Children Program. This audit did not result in recommendations to TMHP. Issued April 29, 2021.

The IG Quarterly Report for the second quarter of fiscal year 2021.

OIG evaluated whether Cenikor’s treatment services (a) were provided in accordance with requirements, (b) were provided by qualified staff, and (c) supported the payment received. Issued February 26, 2021.

This inspection assessed whether HHSC-HR performed preemployment due diligence checks for direct support professionals hired to work at SSLCs consistent with (a) Texas Administrative Code requirements and (b) HHSC-HR policies and procedures. Issued February 25, 2021.

The audit objectives were to determine whether (a) the affiliate reporting exception met state and contractual requirements and (b) expenses paid to MCNA Texas's affiliate third-party administrator were accurately reported to HHSC and aligned with its affiliate agreement. This audit did not result in recommendations to MCNA Insurance Company. Issued February 25, 2021.

The OIG Audit Division contracted Myers and Stauffer, LC to audit pharmacy claims to verify services provided to recipients, paid by Texas Medicaid. Issued February 3, 2021.

The audit assessed the design and effectiveness of selected security controls over confidential HHS System information stored and processed by Parkland Community Health Plan, Inc. Issued January 20, 2021.

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.