Reports

State Hospital Investigations Report FY 2023
The Annual Report of State Hospital Investigations for fiscal year 2023.

State Supported Living Center Investigations Report FY 2023
The Annual Report of State Supported Living Center Investigations for fiscal year 2023.

Managed Care Claims Submitted by Medical Plus Supplies
The inspection objective was to determine whether Medical Plus Supplies supported its wound care supply claims according to guidelines. Issued October 10, 2023. OIG Report No. INS-24-002

Managed Care Claims Submitted by Byram Healthcare Centers
Executive Summary The inspection objective was to determine whether Byram supported its wound care supply claims according to guidelines. Issued October 6, 2023. OIG Report No. INS-24-001

PARIS-VA Match Report
The annual PARIS-VA Match Report for fiscal year 2023.

Consolidated SB 30 Report
The Consolidated Senate Bill 30 Annual Report for fiscal year 2023.

Quarterly Report: Quarter 4, FY 2023
The OIG Quarterly Report for the fourth quarter of fiscal year 2023.

Managed Care Pharmacy Encounters Paid to Bemaj Pharmacy, Inc.: A Managed Care Network Provider Contracted Under Amerigroup Texas, Inc., Amerigroup Insurance Company, and Superior HealthPlan, Inc.
Executive Summary

The audit objective was to determine whether Bemaj Pharmacy, Inc. (a) properly billed for selected paid encounters associated with Texas Medicaid members enrolled with Amerigroup and Superior and (b) complied with applicable contractual, state, and federal requirements. Issued September 1, 2023. OIG Report No. AUD-24-001.

Ambulance Claims Oversight: Community First Health Plans
Executive Summary

The inspection objective was to determine whether Community First Health Plans has processes and controls to ensure non-medically necessary ambulance claims are denied in compliance with applicable requirements. Issued August 31, 2023. OIG Report No. INS-23-012.

Rolling Audit and Inspections Plan 2024
The OIG has updated its Rolling Audit and Inspections Plan, which outlines potential audit and inspections areas and topics.The OIG Audit and Inspections Division conducts a continuous risk assessment to identify potential topics for inclusion in its Rolling Audit and Inspections Plan. Potential audit and inspections topics consist of programs, services, providers and contractors with an elevated potential for fraud, waste and abuse.

Roberto Canales M.D.P.A.
The OIG Audit and Inspections Division contracted Weaver and Tidwell to determine whether telemedicine 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, 2023. OIG Report No. AUD-23-036.

The Bridge Over Troubled Waters, Inc.
Executive Summary

The OIG conducted an audit to determine whether The Bridge Over Troubled Waters, a Family Violence Program contractor, had financial processes and controls in place to ensure grant expenditures were accurate, allowable, and supported. Issued August 30, 2023. OIG Report No. AUD-23-035

Ambulance Claims Oversight: Driscoll Health Plan
Executive Summary

The inspection objective was to determine whether Driscoll has processes and controls to ensure non-medically necessary ambulance claims are denied in compliance with applicable requirements. Issued August 29, 2023. OIG Report No. INS-23-011.

Edinburg Pediatric Network
The OIG Audit and Inspections Division contracted Weaver and Tidwell to determine whether telemedicine 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 29, 2023. OIG Report No. AUD-23-034.

Driscoll Children’s Health Plan Special Investigative Unit
Executive Summary

The OIG evaluated whether Driscoll complied with selected state and contractual requirements related to (a) preventing, detecting, and investigating fraud, waste and abuse and (b) reporting reliable information on SIU activities, results and recoveries to the OIG. Issued August 23, 2023. OIG Report No. AUD-23-032.