Reports

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

The annual PARIS-VA Match Report for fiscal year 2020.

The Consolidated Senate Bill 30 Annual Report for fiscal year 2020.

The audit objective was to determine whether Parkland and its subcontracted Pharmacy Benefits Manager, Navitus, administered formularies, the preferred drug list, and prior authorizations in accordance with the contractual requirements. Issued August 31, 2020.

The audit objective was to determine whether Community Health Choice and its subcontracted Pharmacy Benefits Manager, Navitus, administered formularies, the preferred drug list, and prior authorizations in accordance with the contractual requirements. Issued August 31, 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 Amerigroup accurately and timely adjudicated qualified nursing facility provider clean claims in compliance with selected criteria. Issued August 28, 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 UnitedHealthcare accurately and timely adjudicated qualified nursing facility provider clean claims in compliance with selected criteria. Issued August 28, 2020.

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.

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 Cigna-HealthSpring accurately and timely adjudicated qualified nursing facility provider clean claims in compliance with selected criteria. 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.