OIG audits dental maintenance organization

The OIG completed an audit of DentaQuest USA Insurance Company, Inc., a Texas Medicaid and CHIP Dental Maintenance Organization. The audit objective was to evaluate the effectiveness of DentaQuest’s performance in complying with selected contract requirements, achieving related contract outcomes, and reporting financial and performance results to HHS.

Audit results indicated that DentaQuest’s 2017 Administrative Expenses financial statistical report (FSR) included unsupported, overstated or unallowable expenses. In addition, DentaQuest did not routinely review, monitor and remove unnecessary accounts that have access to Texas HHS agency sensitive or confidential information. DentaQuest adjudicated paid dental claims selected for review in accordance with requirements, and reasonably processed and resolved selected provider complaints.

Auditors offered recommendations to Texas Medicaid and CHIP Services which, if implemented, will address unallowable, unsupported or overstated expenses reported on DentaQuest’s Administrative Expenses FSR for 2017 and other years, and strengthen access controls to financial systems used to process and report financial information. Read the full audit.