About OIG Audit reports

September 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 audit determined whether Medicaid and CHIP Services, through monitoring selected contract deliverables, effectively managed the STAR Kids and STAR Health programs for the Medically Dependent Children Program (MDCP). Issued August 30, 2019.

The audit determined whether services were authorized and provided to STAR Kids members in MDCP who received private duty nursing, and service coordination activities, assessments, and service plans supported the services for MDCP members who received private duty nursing.

The audit determined whether services were authorized and provided to STAR Kids members in MDCP who received private duty nursing, and service coordination activities, assessments, and service plans supported the services for MDCP members who received private duty nursing.

The audit objective was to evaluate the MCNA’s effectiveness in complying with selected contract requirements, achieving related contract outcomes, and reporting financial and performance results to HHSC. Issued August 30, 2019.

The audit was to determine whether contract funds were used as intended and the contractor billed and performed as required. No issues were noted. Issued August 28, 2019.

The audit evaluated Medicine Man 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 August 22, 2019.

The audit was conducted to determine whether LogistiCare’s performance in selected areas was in accordance with contract requirements. Issued August 22, 2019.

This audit evaluated whether Cigna complied with contractual requirements for performing service coordination in support of STAR+PLUS Level 1 members. Issued August 22, 2019.

The audit was conducted to determine whether confidential HHS System information in the custody of Texas Children’s Health Plan and its subcontractors was protected from unauthorized access, loss, or disclosure. Issued July 31, 2019.

The audit was conducted to determine whether Amistad’s performance in selected areas was in accordance with contract requirements. Issued July 23, 2019.

The audit determined whether delivery of selected pharmacy benefits by Molina and its subcontracted PBM, Caremark, was effective and in compliance with criteria in the Uniform Managed Care Contract, the Uniform Managed Care Manual, and applicable state rules and statutes.

The audit was conducted to determine whether MTM’s performance in selected areas was in accordance with contract requirements. Issued July 17, 2019.

This audit evaluated whether Amerigroup complied with contractual requirements for performing service coordination in support of STAR+PLUS Level 1 members. Issued July 15, 2019.

This audit evaluated whether DFPS child-specific contract payments were made to psychiatric hospitals only for services not covered by STAR Health. Issued July 15, 2019.

The audit evaluated Best Med 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 3, 2019.

This audit evaluated whether United complied with contractual requirements for performing service coordination in support of STAR+PLUS Level 1 members. Issued June 26, 2019.

The audit was conducted to determine whether AMR’s performance in selected areas was in accordance with contract requirements. Issued June 18, 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.

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.

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