FY 2017 Annual Report

September 2017 Quarterly

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

Recovery of Funds Issue Brief

September 2017 Other

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.

The audit evaluated Houston Medicine Chest, 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 3, 2017.

Pediatric Dental Sedation

July 2017 Inspections

This report details the inspection of Texas Medicaid providers to determine if dental sedation procedures performed on Medicaid pediatric patients are medically necessary and meet the standard of care. Issued July 14, 2017.

Quarterly Report June 2017

June 2017 Quarterly

The IG Quarterly Report for the third quarter of fiscal year 2017.

Opioid Drug Utilization

May 2017 Inspections

This report details the inspection of Texas Medicaid efforts to reduce prescription opioid abuse and overutilization. Issued May 30, 2017.

The IG Audit Division has completed this informational report, Dental Service Organizations, to gain an understanding of DSOs and how they support the delivery of dental services provided to Medicaid and CHIP-eligible individuals. Issued May 31, 2017. Revised November 14, 2017.

The IG Audit Division has completed Audit of the University of Texas Medical Branch at Galveston Cost Report: Fiscal Year 2014.

The IG Audit Division has completed Audit of Acute Care Utilization Management in Managed Care Organizations: Amerigroup Texas, Inc. and Amerigroup Texas Insurance Company.

Quarterly Report March 2017

March 2017 Quarterly

The IG Quarterly Report for the second quarter of fiscal year 2017.

The IG Audit Division has completed the Audit of DADS Claims Management System: Information Technology Interface Processing Controls.

The IG Audit Division has completed the report Deep East Texas Council of Governments: While HHS Contract Funds Were Used as Intended, Financial and IT Controls Should be Improved.

The IG Audit Division has completed the informational report Medicaid and CHIP MCO Special Investigative Units: Initiatives Underway to Improve Collaboration and Performance.

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