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 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 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 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.
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.
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 audit evaluated Blue Cross and Blue Shield’s policies and practices associated with preventing, detecting, investigating, and reporting fraud, waste, and abuse. Issued September 28, 2018.
The audit was conducted to determine whether confidential HHS System information in the custody of Community First and its subcontractors was protected from unauthorized access, loss, or disclosure. Issued August 2, 2018.
The audit evaluated Premier Care Pharmacy Services 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 July 31, 2018.
The audit evaluated Amber Pharmacy 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 July 31, 2018.
The audit evaluated whether Himmel complied with Texas Medicaid requirements for speech therapy authorizations, discontinuation, and claims billing; licensure, certification, and supervision of speech therapists; and medical necessity of speech therapy treatments. Issued July 23, 2018.
The OIG Audit Division performed an inventory of selected drugs to determine whether Richard's Pharmacy correctly billed Medicaid, complied with requirements, and maintained sound controls over its related IT systems for the audit period. Issued June 27, 2018.
The audit evaluated Specialty Therapeutic Care 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 May 31, 2018.
