Reports

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.

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

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.

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.

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

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.

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

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.

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 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.

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

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