Reports

One Source Medical Group
The OIG Audit and Inspections Division contracted DK Partners to audit whether delivery of Durable Medical Equipment and submissions of Medicaid and CHIP managed care claims by One Source were in accordance with applicable Federal and State Medicaid laws, regulations, rules, policies, and contractual requirements.  Issued August 31, 2022.

Heart of Texas Region MHMR Center n/k/a Heart of Texas Behavioral Health Network
The OIG Audit and Inspections Division contracted Weaver and Tidwell, L.L.P. to audit whether services billed and paid under the state Medicaid program were provided in accordance with applicable state and federal Medicaid laws, regulations, rules, policies, and contractual requirements. Issued August 31, 2022.

 

Y Medical Associates, Inc.
The OIG Audit and Inspections Division contracted Myers and Stauffer LC to audit whether pharmacy claims billed 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 29, 2022.

Aeroflow Inc.
The OIG Audit and Inspections Division contracted DK Partners to audit whether delivery of Durable Medical Equipment and submissions of Medicaid and CHIP managed care claims by Aeroflow were in accordance with applicable Federal and State Medicaid laws, regulations, rules, policies, and contractual requirements.  Issued August 30, 2022.

Southside Pharmacy 9
The OIG Audit and Inspections Division contracted Myers and Stauffer LC to audit whether pharmacy claims billed 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 29, 2022.

Inpatient Psychiatric Hospitals: West Oaks Hospital
Executive Summary - The audit objective was to determine whether West Oaks completed admission, commitment, and specific consent requirements for STAR+PLUS members receiving inpatient psychiatric services in accordance with selected federal and state regulations, rules, and policies. Issued August 26, 2022. OIG Report No. AUD-22-026.

Inpatient Psychiatric Hospitals: Cypress Creek Hospital
Executive SummaryThe audit objective was to determine whether Cypress Creek completed admission, commitment, and specific consent requirements for STAR+PLUS members receiving inpatient psychiatric services in accordance with selected federal and state regulations, rules, and policies. Issued August 25, 2022. OIG Report No. AUD-22-025.

Texas Home Modification Services
The OIG Audit and Inspections Division contracted DK Partners to determine whether delivery of Durable Medical Equipment and submissions of Medicaid and CHIP managed care claims by Texas Home Modification Services were in accordance with applicable Federal and State Medicaid laws, regulations, rules, policies, and contractual requirements. Issued August 26, 2022.

Administrative and Medical Expenses Reported on Financial Statistical Reports: UnitedHealthcare Community Plan of Texas, L.L.C. and UnitedHealthcare Insurance Company, Inc.
Executive Summary - The audit objective was to determine whether (a) UnitedHealthcare reported expenses on selected components of its Medical and Combined financial statistical reports submitted to the Texas Health and Human Services Commission (HHSC) in accordance with contract requirements and laws and (b) the related internal controls over the preparation of the financial statistical reports were designed and operating effectively. Issued August 24, 2022. OIG Report No. AUD-22-024.

Nursing Facility Emergency Preparedness: Mystic Park Nursing and Rehabilitation Center
Executive Summary - The inspection objective was to determine whether Mystic Park Nursing and Rehabilitation Center followed select state and federal requirements for emergency preparedness. Issued August 25, 2022. OIG Report No. INS-22-010.

Acorn Pharmacy
The OIG Audit and Inspections Division contracted Myers and Stauffer LC to audit whether pharmacy claims billed 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 19, 2022.

Emergency Ambulance Services at American Medical Response
Executive Summary - The audit objective was to determine whether American Medical Response ensured its contractor billed claims to managed care organizations in accordance with applicable statutes, rules, and procedures in the managed care environment. Issued August 18, 2022. OIG Report No. AUD-22-022.

Amber Pharmacy
The OIG Audit and Inspections Division contracted Myers and Stauffer LC to audit whether pharmacy claims billed 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 19, 2022.

Clinical Laboratory Improvement Amendments (CLIA) Certification: Texas Medicaid and Healthcare Partnership (TMHP)
Executive SummaryThe inspection objective was to determine whether TMHP has controls to ensure payments made to laboratories are only for services covered under the laboratory's CLIA certification level. Issued August 19, 2022. OIG Report No. INS-22-009.

Managed Care Pharmacy Claims Paid to ReCept Pharmacy #1: A Managed Care Network Provider Contracted Under Aetna Better Health of Texas, Inc.
Executive Summary - The audit objective was to determine whether ReCept Pharmacy #1 (a) properly billed for paid claims associated with Medicaid and Children’s Health Insurance Program (CHIP) members enrolled with Aetna Better Health of Texas, Inc. and (b) complied with applicable contractual, state, and federal requirements. Issued August 22, 2022. OIG Report No. AUD-22-023.