Reports
September 2020
The IG Quarterly Report for the fourth quarter of fiscal year 2020.
Category: QuarterlyThe annual PARIS-VA Match Report for fiscal year 2020.
Category: OtherThe Consolidated Senate Bill 30 Annual Report for fiscal year 2020.
Category: Other
August 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.
Category: AuditThe 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.
Category: AuditOIG 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.
Category: AuditOIG 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.
Category: AuditThe 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.
Category: AuditOIG 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.
Category: AuditThis 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.
Category: AuditThe 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.
Category: AuditThe 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.
Category: AuditThe 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.
Category: AuditThis 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.
Category: Audit- Durable Medical Equipment Delivered to Deceased Beneficiaries: All Star Medical Equipment and Supply
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.
Category: Audit