The IG Quarterly Report for the first quarter of fiscal year 2018.
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Review of Managed Care Organizations' Cost Avoidance and Waste Prevention Activities
March 2018 OtherThis report was submitted to the Legislative Budget Board and the Governor in compliance with the 2018-2019 General Appropriations Act, Senate Bill 1, 85th Legislature, Regular Session, 2017 (Article II, Health and Human Services Commission, Rider 151.) Issued March 1, 2018.
Security Controls Over Confidential HHS System Information: MAXIMUS Enrollment Broker
February 2018 AuditThe audit evaluated the design and effectiveness of selected security controls over confidential HHS System information stored and processed by MAXIMUS. Issued February 23, 2018.
The audit evaluated Southside Pharmacy 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 February 9, 2018; revised February 28, 2018.
This report was submitted to the Legislative Budget Board and the Governor in compliance with the 2018-2019 General Appropriations Act, Senate Bill 1, 85th Legislature, Regular Session, 2017 (Article II, Health and Human Services Commission, Rider 153). Issued February 1, 2018.
The audit evaluated whether fee-for-service claims for incontinence supplies paid with Medicaid funds were billed in accordance with state laws, regulations, and program requirements. Test results indicated no exceptions. Issued December 20, 2017.
Homelife and Community Services, Inc.: A Texas Home and Community-Based Services Program Provider
November 2017 AuditThis audit evaluated whether claims for Residential Support Services submitted by and paid to Homelife and authorizations for billed Day Habilitation services existed were properly documented. Issued November 30, 2017.
Audit of Children’s Hope Residential Services, Inc.: Residential Child-Care Contracts with The Texas Department of Family and Protective Services
November 2017 AuditThe audit evaluated whether state funds were used as intended for facility maintenance and payments to foster parents and whether Children’s Hope met contract requirements for supervising children, performing inventories, and documenting services. Issued November 30, 2017.
Audit of Wee-Care Pediatric Specialty Therapeutic: A Medicaid Speech Therapy Provider
November 2017 AuditThe audit evaluated whether Wee-Care complied with Texas Medicaid requirements for speech therapy claims billing, prior authorizations, speech therapy duration and total number of visits, and credentialing of speech language pathologist assistants and interns. Issued November 20, 2017.
The Joint Annual Report on Fraud and Abuse in Medicaid, compiled by IG and the Attorney General's Medicaid Fraud Control Unit, for fiscal year 2017.
Pharmacy Benefit Managers in Texas: Informational Report on the Role of PBMs in Delivering Medicaid and CHIP Pharmacy Benefits to Managed Care Members
November 2017 AuditThis report describes and discusses the functions and components of PBMs in delivering pharmacy services, responsibilities for related performance and oversight, and how the functions and components interact with each other to deliver pharmacy services. Issued November 17, 2017.
The audit evaluated HALO-Flight fee-for-service claims for air ambulance services were billed in accordance with state laws, regulations, and the Texas Medicaid Provider Procedures Manual. Results indicated no exceptions for the claims tested. Issued November 15, 2017.
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.
The Annual Report of State Supported Living Center Investigations for fiscal year 2017.
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.
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.
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.