October 2021
September 2021
Managed Care Claims Submitted by Cook Children’s Home Health and Paid by Cook Children’s Health Plan: A Texas Medicaid Durable Medical Equipment and Supplies Provider
The audit objective was to determine whether documentation to support the authorization and delivery of durable medical equipment (DME) and supplies associated with Medicaid claims submitted by and paid to Cook Children’s Home Health by Cook Children’s Health Plan existed and was completed in accordance with applicable state laws, rules, and guidelines. Issued September 30, 2021.
Quarterly Report: Quarter 4, FY 2021
The OIG Quarterly Report for the fourth quarter of fiscal year 2021.
Cenikor Foundation: Region 6 Substance Use Disorder Treatment Provider
OIG evaluated whether Cenikor’s Region 6 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 September 29, 2021.
PARIS-VA Match Report
The annual PARIS-VA Match Report for fiscal year 2021.
Rolling Audit and Inspections Plan
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.
Consolidated SB 30 Report
The Consolidated Senate Bill 30 Annual Report for fiscal year 2021.
August 2021
Audit of Vida Clinic
The OIG Audit Division contracted Myers and Stauffer LC to audit whether behavioral health 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 31, 2021.
Delivery Supplemental Payments (DSP): Medicaid CHIP Services—Financial Reporting and Audit Coordination (FRAC)
The inspection focused on whether FRAC periodically verifies that DSP claims are valid and adequately supported, conducts retrospective reviews of DSP claims, and implemented policies and procedures to ensure delivery supplemental payment claims are processed timely and accurately. Issued August 31, 2021.
Mental Health Targeted Case Management and Mental Health Rehabilitative Services in Managed Care: Local Mental Health Authorities and Local Behavioral Health Authorities in Texas Medicaid
The inspection focused on mental health targeted case management and mental health rehabilitative services provided by local mental health authorities (LMHAs) and local behavioral health authority (LBHA) contracted providers. Issued August 30, 2021.
Avita Pharmacy
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 26, 2021.
Co-Treatment Therapy Billing: Rebound Sports and Physical Therapy
The audit objective was to determine if Rebound performed co-treatment services, which occur when two or more therapy disciplines are performed concurrently, were billed correctly. Issued August 26, 2021.
Health and Safety of Medicaid Beneficiaries in the HHSC Home and Community-Based Services Program: Community Options, Inc.
The audit objective was to evaluate whether Community Options, 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 26, 2021.
Cenikor Foundation: Region 11 Substance Use Disorder Treatment Provider
OIG evaluated whether Cenikor’s Region 11 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 26, 2021.