Reports

PARIS-VA Match Report
The annual PARIS-VA Match Report for fiscal year 2020.

Pharmacy Benefits Manager Navitus Health Solutions LLC: Parkland Community Health Plan
The audit objective was to determine whether Parkland and its subcontracted Pharmacy Benefits Manager, Navitus, administered formularies, the preferred drug list, and prior authorizations in accordance with the contractual requirements. Issued August 31, 2020.

Pharmacy Benefits Manager Navitus Health Solutions LLC: Community Health Choice
The audit objective was to determine whether Community Health Choice and its subcontracted Pharmacy Benefits Manager, Navitus, administered formularies, the preferred drug list, and prior authorizations in accordance with the contractual requirements. Issued August 31, 2020.

Processing of Outlier Nursing Facility STAR+PLUS Claims and Adjustments: UnitedHealthcare Community Plan
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 UnitedHealthcare accurately and timely adjudicated qualified nursing facility provider clean claims in compliance with selected criteria. Issued August 28, 2020.

Processing of Outlier Nursing Facility STAR+PLUS Claims and Adjustments: Amerigroup Texas
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 Amerigroup accurately and timely adjudicated qualified nursing facility provider clean claims in compliance with selected criteria. Issued August 28, 2020.

Pharmacy Benefits Manager Navitus Health Solutions LLC: Community First Health Plans
The audit objective was to determine whether Community First and its subcontracted Pharmacy Benefits Manager, Navitus, administered formularies, the preferred drug list, and prior authorizations in accordance with the contractual requirements. Issued August 26, 2020.

Processing of Outlier Nursing Facility STAR+PLUS Claims and Adjustments: Cigna-HeathSpring
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 Cigna-HealthSpring accurately and timely adjudicated qualified nursing facility provider clean claims in compliance with selected criteria. Issued August 26, 2020.

Durable Medical Equipment Delivered to Deceased Beneficiaries: Longhorn Health Solutions
This limited-scope audit explored the prevalence of DME services being provided after a Medicaid beneficiary’s death. For the deliveries tested, verification systems showed the beneficiary as eligible at the time of delivery. Therefore, this audit did not result in recommendations to Longhorn. Issued August 25, 2020.

Security Controls Over Confidential HHS Information: Aetna Better Health of Texas
The audit assessed the design and effectiveness of selected security controls over confidential HHS System information stored and processed by Aetna Better Health of Texas. Issued August 24, 2020.

Final Audit Report: Elgin Pharmacy
The OIG Audit Division contracted Myers and Stauffer, LC to audit pharmacy claims to verify services provided to recipients, paid by Texas Medicaid. Issued August 21, 2020.

Final Audit Report: Ennis Pharmacy
The OIG Audit Division contracted Myers and Stauffer, LC to audit pharmacy claims to verify services provided to recipients, paid by Texas Medicaid. Issued August 21, 2020.

Durable Medical Equipment Delivered to Deceased Beneficiaries: Nextra Health
This limited-scope audit explored the prevalence of DME services being provided after a Medicaid beneficiary’s death. For the deliveries tested, verification systems showed the beneficiary as eligible at the time of delivery. Therefore, this audit did not result in recommendations to Nextra. Issued August 20, 2020.

Durable Medical Equipment Delivered to Deceased Beneficiaries: All Star Medical Equipment and Supply
This limited-scope audit explored the prevalence of DME services being provided after a Medicaid beneficiary’s death. For the deliveries tested, verification systems showed the beneficiary as eligible at the time of delivery. Therefore, this audit did not result in recommendations to All Star. Issued August 14, 2020.

Fee-for-Service Claims Submitted by Aveanna Healthcare Medical Solutions: A Texas Medicaid Durable Medical Equipment and Supplies Provider
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 Aveanna as required by state laws, rules, and guidelines. Issued July 30, 2020.

Alamo Area Council of Governments: Local Developmental and Disability Authority Performance and Medicaid Contracts
This audit determined whether contract controls ensured AACOG coordinated services to enrollees, monitored service delivery and reported general revenue expenses according to contract requirements, and documented paid encounters. Issued July 29, 2020.