Reports

The audit objective was to determine whether Community First and its subcontracted Pharmacy Benefits Manager, Navitus, administered formularies, the preferred drug list, and prior authorizations in accordance with the contractual requirements. Issued August 26, 2020.

This limited-scope audit explored the prevalence of DME services being provided after a Medicaid beneficiary’s death. For the deliveries tested, verification systems showed the beneficiary as eligible at the time of delivery. Therefore, this audit did not result in recommendations to Longhorn. Issued August 25, 2020.

The audit assessed the design and effectiveness of selected security controls over confidential HHS System information stored and processed by Aetna Better Health of Texas. Issued August 24, 2020.

The OIG Audit Division contracted Myers and Stauffer, LC to audit pharmacy claims to verify services provided to recipients, paid by Texas Medicaid. Issued August 21, 2020.

The OIG Audit Division contracted Myers and Stauffer, LC to audit pharmacy claims to verify services provided to recipients, paid by Texas Medicaid. Issued August 21, 2020.

This limited-scope audit explored the prevalence of DME services being provided after a Medicaid beneficiary’s death. For the deliveries tested, verification systems showed the beneficiary as eligible at the time of delivery. Therefore, this audit did not result in recommendations to Nextra. Issued August 20, 2020.

This limited-scope audit explored the prevalence of DME services being provided after a Medicaid beneficiary’s death. For the deliveries tested, verification systems showed the beneficiary as eligible at the time of delivery. Therefore, this audit did not result in recommendations to All Star. Issued August 14, 2020.

The audit evaluated whether there was valid support for the authorization and delivery of fee-for-service durable medical equipment and supplies associated with Medicaid claims submitted by and paid to Aveanna as required by state laws, rules, and guidelines. Issued July 30, 2020.

This audit determined whether contract controls ensured AACOG coordinated services to enrollees, monitored service delivery and reported general revenue expenses according to contract requirements, and documented paid encounters. Issued July 29, 2020.

The IG Quarterly Report for the third quarter of fiscal year 2020.

The audit evaluated Infinity Pharmacy Solutions, LLC 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 June 23, 2020.

The OIG Audit and Inspections Division contracted Myers and Stauffer, LC to audit behavioral health records to verify services provided to recipients, paid by Texas Medicaid. Issued June 15, 2020.

The audit evaluated Molina’s policies and practices associated with preventing, detecting, investigating, and reporting fraud, waste and abuse. Issued May 22, 2020.

The audit evaluated Tarrytown Expocare, LLC 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 11, 2020.

The audit assessed the design and effectiveness of selected security controls over confidential HHS System information stored and processed by El Paso Health. Issued April 24, 2020.