Issue Brief: Encounter Data

January 2019 Issue Briefs

This Issue Brief outlines how the OIG uses encounter data (a record of paid cliams by MCOs and DMOs) to monitor and detect fraud, waste, and abuse. Issued January 17, 2019.

This report details the inspection to determine if HHSC Access and Eligibility Services properly addresses non-verified Social Security numbers to prevent ineligible client enrollment in Texas Medicaid. Issued January 3, 2019.

Quarterly Report: Quarter 1, FY 2019

December 2018 Quarterly

The IG Quarterly Report for the first quarter of fiscal year 2019.

About OIG Audit reports

December 2018 Audit

Final audit reports are posted to the OIG website when issued. These reports are subject to appeal upon timely, written, proper requests for appeal, as provided for in rule. These final audit reports are public records and remain posted on the website during and after an appeal.

This audit evaluated whether fee-for-service claims submitted by and paid to Bethesda Lutheran were authorized, documented, and billed in accordance with the HCS provider agreement and with state rules and guidelines. Issued December 14, 2018.

The audit evaluated Avita Drugs to determine whether it properly billed VDP and complied with contractual and state requirements, and evaluated IT general controls to determine whether data used for audit testing was reliable. Issued November 30, 2018.

The audit evaluated Passage of Youth to determine whether it (a) used state funds as intended for foster children, (b) conducted oversight of foster parents, and (c) implemented and updated children’s service plans. Issued November 30, 2018.

The audit was conducted to determine whether confidential HHS System information in the custody of Amerigroup and its subcontractors was protected from unauthorized access, loss, or disclosure. Issued November 30, 2018.

This audit evaluated whether claims for residential support services and supervised living submitted by and paid to Lakes Regional and authorizations for other HCS services existed were properly documented. Issued November 30, 2018.

This audit evaluated whether claims for residential support services and supervised living submitted by and paid to Mission Road and authorizations for other HCS services existed were properly documented. Issued November 30, 2018.

The audit evaluated Cystic Fibrosis Services, Inc. to determine whether it properly billed VDP and complied with contractual and state requirements, and evaluated IT general controls to determine whether data used for audit testing was reliable. Issued November 26, 2018.

Joint OIG-MFCU Report

November 2018 Other

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 2018.

MCO Fraud Recoveries Report

November 2018 Other

The Annual Report on Certain Fraud and Abuse recoveries for fiscal year 2018.

SSLC Investigations Report

November 2018 Other

The Annual Report of State Supported Living Center Investigations for fiscal year 2018.

The Annual Report of State Hospital Investigations for fiscal year 2018.

Data Review: Medicaid Lock-In Program

October 2018 Issue Briefs

This data review provides an overview of the Medicaid Lock-In Program, which is used to restrict the overuse of medical services.

The OIG presentation given to the House Committee on General Investigating and Ethics on October 25, 2018.

The objectives of this audit were to determine whether claims were authorized, documented, and billed in accordance with the provider agreement, state rules, and guidelines Results indicated no exceptions for the records or claims tested. Issued October 15, 2018.

The IG Quarterly Report for the fourth quarter of fiscal year 2018.

PARIS-VA Match Report

October 2018 Other

The annual PARIS-VA Match Report for fiscal year 2018.

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