The audit objective was to evaluate activities designed to analyze eligibility determination errors for benefit programs managed by the Texas Health and Human Services (HHS) System. Issued November 13, 2017.

The Annual Report of State Hospital Investigations for fiscal year 2017.

SSLC Investigations Report

November 2017 Other

The Annual Report of State Supported Living Center Investigations for fiscal year 2017.

MCO Fraud Recoveries Report

November 2017 Other

The Annual Report on Certain Fraud and Abuse recoveries for fiscal year 2017.

The audit objective was to determine whether the amounts in the capitalization and moveable equipment cost centers reported on the Providence Memorial Hospital cost report were accurate, allowable, and adequately supported according to CMS and state requirements. Issued October 31, 2017.

The audit objective was to determine whether therapy services at Sunny Springs were provided consistent with physician orders and in accordance with resident assessments and evaluations. Issued October 25, 2017.

Treasury Offset Program

October 2017 Inspections

This report details the inspection of procedures to maximize recovery of Supplemental Nutrition Assistance Program overpayments through the Treasury Offset Program. Issued October 20, 2017.

Issue Brief: Value-Based Payments

October 2017 Issue Briefs

This issue brief provides an overview of value-based payments, which are structured to incentivize providers to delivery quality care in the most cost-effective manner.

Consolidated SB 30 Report

October 2017 Other

The Consolidated Senate Bill 30 Annual Report for fiscal year 2017.

PARIS-VA Match Report

October 2017 Other

The annual PARIS-VA Match Report for fiscal year 2017.

Speech Therapy

October 2017 Inspections

This report details the inspection of Texas Medicaid providers to examine MCO controls for prior authorization, best practices to strengthen controls, medical necessity for authorization, and speech therapy utilization rates across managed care service areas. Issued October 2, 2017.

Annual Report: FY 2017

September 2017 Quarterly

The IG Annual Report for fiscal year 2017, including the report from the fourth quarter.

Issue Brief: Recovery of Funds

September 2017 Issue Briefs

This issue brief provides an overview of new state and federal guidelines for Medicaid managed care organizations about the recovery of improper payments and how other states distribute recovered Medicaid funds.

The audit evaluated Maxor National Pharmacy Service 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 August 31, 2017.

The audit objective was to determine whether the amounts in the capitalization and moveable equipment cost centers reported on the Lake Pointe Medicare cost report were accurate, allowable, and adequately supported according to CMS and state requirements. Issued August 31, 2017.

The audit evaluated HEB Pharmacy #084 to determine whether it properly billed VDP and complied with certain requirements.  Issued August 31, 2017.

The audit evaluated US Bioservices 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.  Results indicated no exceptions for the claims tested.

The audit was conducted to determine whether confidential HHS System information in the custody of FirstCare and its subcontractors was protected from unauthorized access, loss, or disclosure. Issued August 22, 2017.

This informational report summarizes acute care utilization management practices in managed care organizations based on the results of four audits performed by the HHSC IG Audit Division. Issued August 15, 2017.

The objectives of the audit were to evaluate whether MedCare complied with certain Texas Medicaid requirements. Issued August 11, 2017.

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