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.
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 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.
The audit evaluated Minimum Data Set (MDS) assessments, therapy services charts, medical records, Resource Utilization Group (RUG) levels assigned to residents, and physician orders and certifications for therapy services. Issued May 11, 2018.
The audit evaluated Cook Children’s Home Health 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.
The audit evaluated whether fee-for-service claims for incontinence supplies paid with Medicaid funds were billed in accordance with state laws, regulations, and program requirements. Issued April 27, 2018.
The audit evaluated Driscoll’s policies and practices associated with preventing, detecting, investigating, and reporting fraud, waste, and abuse. Issued April 3, 2018.
The audit evaluated the design and effectiveness of selected security controls over confidential HHS System information stored and processed by MAXIMUS. Issued February 23, 2018.
The audit evaluated Southside 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 February 9, 2018; revised February 28, 2018.
The audit evaluated whether fee-for-service claims for incontinence supplies paid with Medicaid funds were billed in accordance with state laws, regulations, and program requirements. Test results indicated no exceptions. Issued December 20, 2017.
This audit evaluated whether claims for Residential Support Services submitted by and paid to Homelife and authorizations for billed Day Habilitation services existed were properly documented. Issued November 30, 2017.
The audit evaluated whether state funds were used as intended for facility maintenance and payments to foster parents and whether Children’s Hope met contract requirements for supervising children, performing inventories, and documenting services. Issued November 30, 2017.
The audit evaluated whether Wee-Care complied with Texas Medicaid requirements for speech therapy claims billing, prior authorizations, speech therapy duration and total number of visits, and credentialing of speech language pathologist assistants and interns. Issued November 20, 2017.
This report describes and discusses the functions and components of PBMs in delivering pharmacy services, responsibilities for related performance and oversight, and how the functions and components interact with each other to deliver pharmacy services. Issued November 17, 2017.
