Reports

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.

OIG completed an inspection to determine whether fee-for-service telemonitoring provider services were consistent with selected state requirements. No exceptions to requirements were observed. Issued: April 29, 2021.

OIG conducted an audit of select long-term care eligibility processes at the Texas Medicaid and Healthcare Partnership (TMHP) for new members enrolling in the Medically Dependent Children Program. This audit did not result in recommendations to TMHP. Issued April 29, 2021.

The IG Quarterly Report for the second quarter of fiscal year 2021.

OIG evaluated whether Cenikor’s treatment services (a) were provided in accordance with requirements, (b) were provided by qualified staff, and (c) supported the payment received. Issued February 26, 2021.

This inspection assessed whether HHSC-HR performed preemployment due diligence checks for direct support professionals hired to work at SSLCs consistent with (a) Texas Administrative Code requirements and (b) HHSC-HR policies and procedures. Issued February 25, 2021.

The audit objectives were to determine whether (a) the affiliate reporting exception met state and contractual requirements and (b) expenses paid to MCNA Texas's affiliate third-party administrator were accurately reported to HHSC and aligned with its affiliate agreement. This audit did not result in recommendations to MCNA Insurance Company. Issued February 25, 2021.

The OIG Audit Division contracted Myers and Stauffer, LC to audit pharmacy claims to verify services provided to recipients, paid by Texas Medicaid. Issued February 3, 2021.

The audit assessed the design and effectiveness of selected security controls over confidential HHS System information stored and processed by Parkland Community Health Plan, Inc. Issued January 20, 2021.

This report provides a summary and overview of the results and issues identified during audits of three managed care organizations that all subcontracted with Navitus as their pharmacy benefits manager. The audits, which were conducted in 2020, were of Community First Health Plans, Parkland Community Health Plan, and Community Health Choice. Published January 8, 2021.

Value-based purchasing (VBP) models are utilized in government health insurance programs to shift payments from volume to value. This informational report explores how VBP has evolved nationally, Texas’ implementation and a discussion of potential program integrity challenges and considerations related to the OIG’s future work in this space. Issued December 21, 2020. Summary version.

The IG Quarterly Report for the first quarter of fiscal year 2021.

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 2020.

This inspection assessed whether ACH Child and Family Services conducted CANS 2.0 assessments for children entering community-based care and provided services to those children timely. Published December 18, 2020

OIG conducted this audit as a follow-up to complaints of nursing facility payments being delayed by more than 90 days and of unprocessed retroactive adjustments. The audit objective was to determine whether Molina accurately and timely adjudicated qualified nursing facility provider clean claims in compliance with selected criteria. Issued December 9, 2020.