About OIG Audit reports

June 2019 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.

The OIG Data and Technology presentation on Dental Solicitation Analysis given to stakeholders on June 6 and 7, 2019.

Nursing facilities billed Texas Medicaid MCOs an estimated $39.2 million more for resident daily care in 2017, by clustering therapy services during MDS assessment look-back periods, than they would have billed if Texas Medicaid policy prohibited the practice of clustering. Issued June 6, 2019.

This OIG review is an assessment of the Texas Health and Human Services Commission's Medicaid capitation rate setting process. Issued May 23, 2019.

The audit evaluated whether documentation to support the authorization and delivery of fee-for-service DME and supplies associated with Medicaid claims submitted by and paid to Longhorn existed and were completed in accordance with state laws, rules, and guidelines. Issued May 9, 2019.

The audit evaluated Pharmacy Alternatives 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 April 25, 2019.

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

This report details the inspection to determine if managed care organization member complaint intake processes are consistent with the Uniform Managed Care Contract and Uniform Managed Care Manual requirements. Issued March 7, 2019.

This report details the inspection to determine if documentation requirements are being met when Medicaid clients receive power wheelchairs from durable medical equipment suppliers. Issued February 27, 2019.

This report details the inspection to determine the program integrity activities pharmacy benefit managers use to detect fraud, waste, and abuse of Medicaid-funded prescriptions. Issued February 27, 2019.

The audit evaluated Epic to determine whether it properly billed the MCO FirstCare Health Plans for Medicaid claims and complied with contractual and state requirements. Issued February 26, 2019.

The audit evaluated whether paid Medicaid claims for air ambulance services and their associated ground transports were billed in accordance with state rules and guidelines, and contractual requirements. Issued February 26, 2019

The objective of the audit was to determine the reliability of UnitedHealthcare sub-capitated encounter data and claims-based encounter data.  Issued February 26, 2019.

The OIG presentation on technology projects given to the House Appropriations Subcommittee on Article II on February 19, 2019.

This article explains how to prevent being the target of fraud or abuse in your home. Issued February 15, 2019.

This article explains how to prevent being the target of fraud or abuse by dental solicitors. Issued February 15, 2019.

The OIG presentation given to the House Appropriations Subcommittee on Article II on February 12, 2019.

The audit evaluated Metscript Pharmacy No. 2 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 February 11, 2019.

The OIG presentation given to the Senate Finance Committee on February 5, 2019.

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.

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